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Hospital charges of potentially preventable pediatric hospitalizations
1Center for Applied Research and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. SamLuUAMS@gmail.com
Insights
Potentially preventable pediatric hospitalizations cost billions, with respiratory conditions like asthma and pneumonia being the most common. Interventions should target minority populations and primary care settings.
Area of Science:
- Pediatric healthcare utilization and cost analysis.
- Public health and preventative medicine.
Background:
- Preventable hospitalizations represent a significant financial burden on healthcare systems.
- Limited data exists on the scope of potentially preventable pediatric hospitalizations.
Purpose of the Study:
- To identify the financial charges associated with potentially preventable pediatric hospitalizations.
- To characterize the demographic factors linked to these hospitalizations.
Main Methods:
- Analysis of the 2006 Kids' Inpatient Database (N=7,558,812).
- Utilized International Classification of Diseases, Ninth Revision, Clinical Modification codes for ambulatory care-sensitive (ACS) conditions.
- Regression analyses were performed to identify associated demographic and diagnostic variables.
Main Results:
- Potentially preventable pediatric hospitalizations incurred $4.05 billion in charges and over 1 million hospitalization days in 2006.
- Asthma and bacterial pneumonia accounted for nearly half of all ACS charges and days.
- Male gender, Black or Hispanic ethnicity, and emergency department admission were associated with higher odds of ACS conditions.
Conclusions:
- Respiratory conditions are the primary drivers of preventable pediatric hospitalizations, costing nearly $2 billion.
- Children hospitalized for ACS conditions are often male, non-white, and admitted via the emergency department.
- Future prevention strategies should focus on primary care interventions for respiratory conditions, particularly in minority populations.
Objectives:
Reducing the number of preventable hospitalizations represents a possible source of health care savings. However, the current literature lacks a description of the extent of potentially preventable pediatric hospitalizations. The study objectives are to (1) identify the charges and (2) demographic characteristics associated with potentially preventable pediatric hospitalizations.
Methods:
Secondary analysis of the 2006 Kids' Inpatient Database (weighted N = 7,558,812). International Classification of Diseases, Ninth Revision, Clinical Modification codes for 16 previously validated pediatric ambulatory care-sensitive (ACS) conditions identified potentially preventable hospitalizations; seven additional conditions reflected updated care guidelines. Outcome variables included number of admissions, hospitalization days, and hospital charges. Demographic and diagnostic variables associated with an ACS condition were compared with regression analyses by the use of appropriate person-level weights.
Results:
Pediatric ACS hospitalizations totaled $4.05B in charges and 1,087,570 hospitalization days in 2006. Two respiratory conditions-asthma and bacterial pneumonia-comprised 48.4% of ACS hospital charges and 46.7% of ACS hospitalization days. In multivariate analysis, variables associated with an ACS condition included: male gender (odds ratio [OR] 1.10; 95% confidence interval [95% CI] 1.07-1.13); race/ethnicity of black (OR 1.22; 95% CI 1.16-1.27) or Hispanic (OR 1.12; 95% CI 1.06-1.18); and emergency department as admission source (OR 1.37; 95% CI 1.27-1.48).
Conclusions:
Respiratory conditions comprised the largest proportion of potentially preventable pediatric hospitalizations, totaling as much as $1.96B in hospital charges. Children hospitalized with an ACS condition tend to be male, non-white, and admitted through the emergency department. Future research to prevent pediatric hospitalizations should examine targeted interventions in the primary care setting, specifically around respiratory conditions and minority populations.
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