J Korean Med Sci.  2021 Nov;36(45):e289. 10.3346/jkms.2021.36.e289.

Analysis of Tertiary Hospital Utilization in Pediatric Orthopaedics: a Study Using Nationwide Sample Data from Korea

• Bae K
• Park SS
• Park J
• Kang MS

• KMID: 2522548
• DOI: http://doi.org/10.3346/jkms.2021.36.e289

Abstract

Background
In the Korean medical system, the severity classification for a specific disease depends primarily on its nationwide admission rate in tertiary hospitals. Inversely, one of the important designation criteria for a tertiary hospital is the hospital's treatment ratio of patients classified as having a specific severe disease. Most diseases requiring pediatric orthopaedic surgery (POS) are not currently classified as high severity in terms of disease severity. We investigated the admission rates for the representative POS diseases in tertiary hospitals and compared these rates with those for adult orthopaedic surgery (AOS) diseases.
Methods
Seven POS diagnoses and three AOS diagnoses were selected based on frequency of admission. Nationwide sample data were used to investigate the admission rates for these representative diagnoses from 2008 to 2017.
Results
Six of the seven frequent POS diagnoses presented high admission rates in tertiary hospitals (62.5–92.3%). In contrast, all frequent AOS diagnoses presented low admission rates in tertiary hospitals.
Conclusion
The admission rates of frequent POS diagnoses in tertiary hospitals are high. Considering that these rates are the most important factors for the classification of disease severity, POS diseases seem to be underestimated in terms of severity. This may lead to a tendency for tertiary hospitals to intentionally reduce the admission of children with POS diseases. As a result, these children may not receive appropriate professional care. Therefore, for the disease severity, POS diseases should be classified differently from general AOS diseases by using different criteria reflecting the patient's age.

Keyword

Pediatric Orthopaedics; Tertiary Hospital; Severity

Figure

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  Fig. 1 Admission rates to tertiary hospitals considering the frequent POS and AOS diseases according to patients' age. For patients aged < 15 years with POS diseases, admission rates for all diagnoses to tertiary hospitals are > 60% (62.5–92.3%), except for distal humerus fracture. This 60% is usually set as the cutoff value for the severe disease group.POS = pediatric orthopaedic surgery, AOS = adult orthopaedic surgery, LCPD = Legg-Calve-Perthes disease, SCFE = slipped capital femoral epiphysis, DDH = developmental dysplasia of the hip.

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  Fig. 2 Changes in admission rates to tertiary hospitals for distal humerus fractures over a 10-year period. Trends are given for the periods from 2008 to 2010, 2011 to 2014, and 2015 to 2017. The admission rates in the tertiary hospital for patients aged < 15 years increased over time (line), whereas those for patients aged ≥ 15 years with fractures remained approximately the same (dotted line).

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