Abstract
BACKGROUND: Traditional classification of children's and nonchildren's hospitals is based on physical structure and branding. We grouped hospitals with the most similar types of pediatric patients. METHODS: Retrospective analysis of 2.8 million hospitalizations in 3993 hospitals for patients 0 to 20 years in the 2019 Kids' Inpatient Database. After stratifying low-volume hospitals (greater than 100 annual admissions), we grouped the remaining hospitals using K-means clustering by case-mix of neonatal services and pediatric diagnosis diversity (DD). RESULTS: Clustering distinguished 6 hospital groups. Group 1 (n = 1665 [1.6% of hospitalizations]) represented low pediatric volume hospitals (13 annual pediatric hospitalizations [IQR 3-82]). Group 2 (n = 118 hospitals [1.1% of hospitalizations]) provided no neonatal care, had low DD (12 [IQR 4-34]), and had a median age of 17 years. Group 3 (n = 1156 [19.7% of hospitalizations]) hospitals provided low-severity neonatal care with low DD (13 [IQR 7-19). Group 4 (n = 674 hospitals, [24.0% of hospitalizations]) provided moderate-severity neonatal care (2.2 [ IQR 2.1-2.4]) and increased DD (24 [ IQR 6-34]). Group 5 (n = 238 hospitals [20.5% of hospitalizations]) had a similar severity of neonatal care as group 4 (2.3 [IQR 2.1-2.5]), but 2.7 times greater DD (64 [IQR 55-77]). Group 6 (n = 142 hospitals [33.0% of hospitalizations]) had the highest-severity neonatal care (2.6 [IQR 2.3-3.1]) and the greatest DD (127 [113-140]). CONCLUSION: Children receive inpatient care across 6 groups of hospitals, distinguished by neonatal case-mix and DD. Future studies should investigate the utility of these groups for peer comparisons with health care use and outcomes.