Time trends and payer differences in lengths of initial hospitalization for preterm infants, Arkansas, 2004 to 2010

Area of Science:

• Neonatal health outcomes
• Health services research
• Biostatistics

Background:

• Length of stay (LOS) for preterm infants is a critical metric for healthcare resource utilization and patient outcomes.
• Understanding factors influencing neonatal LOS, such as insurance type and time trends, is essential for effective healthcare planning.
• Preterm infants represent a vulnerable population with complex healthcare needs.

Purpose of the Study:

• To investigate the temporal trends in neonatal length of stay (LOS) for preterm infants in Arkansas from 2004 to 2010.
• To determine if differences in neonatal LOS exist based on insurance type (Medicaid vs. private payer).
• To identify factors contributing to observed differences and trends in neonatal LOS.

Main Methods:

• Analysis of 18,712 preterm infants' data from Arkansas between 2004 and 2010.
• Utilized accelerated failure time models to assess the impact of insurance type and discharge year on neonatal LOS.
• Adjusted models for maternal and infant characteristics, as well as complication and anomaly indicators.

Main Results:

• Initially, Medicaid-insured preterm infants had a 3.2% shorter LOS than privately insured infants.
• An annual increase of 1.6% in expected LOS was observed before accounting for complications.
• After adjusting for complications, insurance-related LOS differences became statistically insignificant, with a persistent annual LOS increase of 0.59%.

Conclusions:

• Apparent disparities in LOS by insurance type were largely explained by higher complication rates among privately insured preterm infants.
• Over half of the observed increase in LOS over time was attributed to increasing complication rates in preterm infants.
• Comorbidity and anomaly rates are crucial confounders when analyzing neonatal LOS trends and insurance-related differences.