Related Experiment Video
Updated: May 18, 2026
Involving Individuals with Developmental Language Disorder and Their Parents/Carers in Research Priority Setting
Published on: June 6, 2020
Prioritization of comparative effectiveness research topics in hospital pediatrics
Ron Keren1, Xianqun Luan, Russell Localio
1Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA. keren@email.chop.edu
Insights
Prioritizing pediatric research requires analyzing hospital costs and resource use. This study identifies high-cost, high-prevalence conditions with significant cost variation for effective research focus.
Area of Science:
- Health Services Research
- Pediatric Hospital Medicine
- Health Economics
Background:
- Comparative effectiveness research (CER) is crucial for optimizing pediatric healthcare.
- Prioritizing CER topics requires understanding disease prevalence, cost, and resource utilization variation.
- Administrative and billing data offer a valuable resource for such analyses.
Purpose of the Study:
- To prioritize comparative effectiveness research topics in hospital pediatrics.
- To utilize data on prevalence, cost, and resource utilization variation for prioritization.
- To identify pediatric conditions that warrant further CER.
Main Methods:
- Retrospective analysis of administrative and billing data from 38 US children's hospitals (2004-2009).
- Included conditions accounting for 80% of all encounters or charges.
- Measured condition-specific prevalence, total standardized cost, and interhospital cost variation using intraclass correlation coefficients and outlier hospital analysis.
Main Results:
- The 10 most expensive conditions constituted 36% of total standardized costs among 495 conditions.
- Of 77 high-prevalence/high-cost conditions, 26 showed significant interhospital cost variation (ICC > 0.10), with 5 exceeding ICC > 0.30.
- Conditions like tonsillectomy, otitis media, and appendicitis surgery exhibited high cost, prevalence, and significant interhospital cost variation.
Conclusions:
- Standardized hospital costs derived from administrative and billing data can effectively identify high-priority CER topics.
- Conditions that are high-cost, high-prevalence, and demonstrate high resource utilization variation are prime candidates for CER.
- This approach facilitates evidence-based resource allocation for pediatric research.
Objective:
To use information about prevalence, cost, and variation in resource utilization to prioritize comparative effectiveness research topics in hospital pediatrics.
Design:
Retrospective analysis of administrative and billing data for hospital encounters.
Setting:
Thirty-eight freestanding US children's hospitals from January 1, 2004, through December 31, 2009.
Participants:
Children hospitalized with conditions that accounted for either 80% of all encounters or 80% of all charges.
Main Outcome Measures:
Condition-specific prevalence, total standardized cost, and interhospital variation in mean standardized cost per encounter, measured in 2 ways: (1) intraclass correlation coefficient, which represents the fraction of total variation in standardized costs per encounter due to variation between hospitals; and (2) number of outlier hospitals, defined as having more than 30% of encounters with standardized costs in either the lowest or highest quintile across all encounters.
Results:
Among 495 conditions accounting for 80% of all charges, the 10 most expensive conditions accounted for 36% of all standardized costs. Among the 50 most prevalent and 50 most costly conditions (77 in total), 26 had intraclass correlation coefficients higher than 0.10 and 5 had intraclass correlation coefficients higher than 0.30. For 10 conditions, more than half of the hospitals met outlier hospital criteria. Surgical procedures for hypertrophy of tonsils and adenoids, otitis media, and acute appendicitis without peritonitis were high cost, were high prevalence, and displayed significant variation in interhospital cost per encounter.
Conclusions:
Detailed administrative and billing data can be used to standardize hospital costs and identify high-priority conditions for comparative effectiveness research--those that are high cost, are high prevalence, and demonstrate high variation in resource utilization.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast, controlled...
01:29Drug Dosing: Infants and Children