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Factors associated with high hospital resource use in a population-based study of children with orofacial clefts
Hilda Razzaghi1, April Dawson, Scott D Grosse
1National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.
Insights
Children with orofacial clefts (OFC) and multiple birth defects incur higher hospital costs and longer stays. Cleft palate cases show the greatest resource utilization, highlighting the need for targeted interventions.
Area of Science:
- Pediatric Health
- Public Health
- Medical Economics
Background:
- Limited understanding of factors influencing hospital resource use in children with orofacial clefts (OFC) in the US.
- Need for population-based data on maternal, child, and system characteristics impacting OFC care.
- Identifying drivers of high healthcare utilization is crucial for resource allocation and patient management.
Purpose of the Study:
- To investigate population-based maternal, child, and system characteristics linked to high hospital resource use in children with OFC.
- To analyze associations between specific factors and high inpatient costs and days for OFC patients.
- To stratify findings by cleft type and presence of other major birth defects.
Main Methods:
- Retrospective, population-based observational study using Florida Birth Defects Registry and hospital discharge records (1998-2006).
- Included 2,129 children with OFC, stratified by cleft type and isolated vs. nonisolated OFC.
- Poisson regression analyzed associations with high hospital resource use (≥90th percentile of days/costs) for birth, postbirth, and total hospitalizations before age 2.
Main Results:
- Low birth weight infants had significantly higher birth hospitalization costs for cleft lip with cleft palate, cleft lip, and cleft palate.
- Multiple birth defects strongly associated with increased inpatient days (3- to 9-fold) and costs (3- to 11-fold).
- These associations were observed for birth, postbirth, and overall hospitalizations.
Conclusions:
- Children with cleft palate exhibited the highest hospital resource utilization.
- The presence of multiple birth defects significantly increases inpatient days and healthcare costs for children with OFC.
- Findings underscore the impact of comorbidities on resource use in OFC care.
Background:
Little is known about population-based maternal, child, and system characteristics associated with high hospital resource use for children with orofacial clefts (OFC) in the US.
Methods:
This was a statewide, population-based, retrospective observational study of children with OFC born between 1998 and 2006, identified by the Florida Birth Defects Registry whose records were linked with longitudinal hospital discharge records. We stratified the descriptive results by cleft type [cleft lip with cleft palate, cleft lip, and cleft palate] and by isolated versus nonisolated OFC (accompanied by other coded major birth defects). We used Poisson regression to analyze associations between selected characteristics and high hospital resource use (≥90th percentile of estimated hospitalized days and inpatient costs) for birth, postbirth, and total hospitalizations initiated before age 2 years.
Results:
Our analysis included 2,129 children with OFC. Infants who were born low birth weight (<2500 grams) were significantly more likely to have high birth hospitalization costs for CLP (adjusted prevalence ratio: 1.6 [95% confidence interval: 1.0-2.7]), CL (adjusted prevalence ratio: 3.0 [95% confidence interval: 1.1-8.1]), and CP (adjusted prevalence ratio: 2.3 [95% confidence interval: 1.3-4.0]). Presence of multiple birth defects was significantly associated with a three- to eleven-fold and a three- to nine-fold increase in the prevalence of high costs and number of hospitalized days, respectively; at birth, postbirth before age 2 years and overall hospitalizations.
Conclusion:
Children with cleft palate had the greatest hospital resources use. Additionally, the presence of multiple birth defects contributed to greater inpatient days and costs for children with OFC.
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