Pediatric hospitalizations for inflammatory bowel disease based on annual case volume: results from the Kids'
Chaitanya Pant1, Abhishek Deshpande2,3, Thomas J Sferra4
1Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, Kansas, USA.
Insights
Pediatric inflammatory bowel disease (IBD) care at high-volume centers (HVCs) involves more procedures and longer stays, but similar complication rates compared to low-volume centers (LVCs). HVCs offer specialized care with higher costs.
Area of Science:
- Pediatric Gastroenterology
- Healthcare Management
- Health Services Research
Background:
- Pediatric inflammatory bowel disease (IBD) care varies across hospitals.
- Understanding differences based on hospital case volume is crucial for optimizing patient outcomes.
- Hospital stratification by annual case volume can reveal disparities in care quality and resource utilization.
Purpose of the Study:
- To compare pediatric IBD care between high-volume centers (HVCs) and low-volume centers (LVCs).
- To identify differences in procedures, outcomes, costs, and length of stay.
- To inform healthcare policy and resource allocation for pediatric IBD management.
Main Methods:
- Cross-sectional study utilizing the US Healthcare Cost and Utilization Project Kids' Inpatient Database (KID).
- Identification of pediatric IBD hospitalizations using ICD-9-CM codes.
- Stratification of 660 hospitals into HVCs (>20 annual IBD admissions) and LVCs (1-20 annual IBD admissions).
Main Results:
- HVCs (n=107) were more likely academic teaching hospitals than LVCs (n=553) (97.1% vs 67.6%).
- Transfer of care from LVCs was higher (5.5%) than from HVCs (0.7%).
- HVCs had more procedures (median 2 vs 1), higher surgical rates (17% vs 10%), greater costs (median $11,000 vs $6,000), and longer stays (median 5 vs 4 days), with similar postoperative complication rates.
Conclusions:
- Pediatric IBD admissions at HVCs involve more comprehensive medical and surgical interventions.
- While HVCs are associated with increased costs and lengthier hospital stays, they demonstrate efficient care coordination with lower transfer rates.
- Further research should explore the cost-effectiveness and long-term outcomes associated with specialized pediatric IBD centers.
Abstract:
To study differences related to pediatric inflammatory bowel disease (IBD) care among hospitals that were stratified based on annual case volume. This is a cross-sectional study using data from the United States Healthcare Cost and Utilization Project Kids' Inpatient Database (KID). IBD-related hospitalizations were identified using International Classification of Diseases-9-Clinical Modification codes. Hospital volume was divided into low or high by assigning cut-off values of 1-20 and >20 annual IBD hospitalizations. We assessed a total of 8647 pediatric IBD discharges during 2012 from 660 hospitals in the USA. 107 of these hospitals were classified as high-volume centers (HVCs) for pediatric IBD care and 553 low-volume centers (LVCs). HVCs were more likely to be associated with an academic teaching status compared to LVCs (97.1% vs 67.6%, p<0.001). The incidence of transfer of medical care from LVCs to other hospitals was 5.5% but only 0.7% for HVCs (p<0.001). The median number of procedures (medical and surgical) performed on children admitted with IBD was higher at HVCs (2 vs 1, p<0.001). IBD admissions at HVCs were more likely to undergo surgical procedures compared to LVCs (17% vs 10%, p<0.001). The incidence of postoperative complications was not significantly different. There were significantly greater hospital costs (median US$11,000 vs US$6,000, p<0.001) and lengths of stay (median 5 days vs 4 days, p<0.001) associated with HVCs compared to LVCs. Pediatric admissions to HVCs for IBD undergo a greater number of medical and surgical procedures and are associated with higher costs and lengthier hospital stays.
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