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Published on: February 16, 2011
Value Narratives: A Novel Method for Understanding High-Cost Pediatric Hospital Patients
Andrew Smith1, Seth Andrews2, Victoria Wilkins3
1Department of Pediatrics, University of Utah, Salt Lake City, Utah; and andrew.gerald.smith@hsc.utah.edu.
Insights
Identifying the top 10% of most costly pediatric inpatients revealed key cost drivers. System errors and medical complications significantly impacted healthcare expenses, highlighting areas for cost-saving interventions.
Area of Science:
- Healthcare Management
- Pediatric Medicine
- Health Economics
Background:
- High-cost inpatients represent a significant financial burden in tertiary pediatric hospitals.
- Understanding the specific drivers of these costs is crucial for effective resource allocation and cost containment strategies.
Purpose of the Study:
- To identify and categorize the primary cost drivers associated with the most expensive inpatient cases in a pediatric tertiary care setting.
- To develop a novel methodology for analyzing cost drivers beyond traditional administrative data.
Main Methods:
- Analysis of the top 10% most costly inpatients from a large regional children's hospital in 2010.
- Random selection of 100 patients (two groups of 50) for detailed chart review across representative specialties.
- Utilized daily cost data and clinical records, with independent reviewers identifying and thematically grouping cost drivers.
- Employed linear regression to assess the association between the number of cost drivers and total inpatient costs.
Main Results:
- Seven major cost drivers were identified: medical complications (49%), system errors (65%), preventable admissions (21%), complex family dynamics (11%), failure to identify family care preferences (9%), futile treatment (6%), and expensive diagnosis without other drivers (15%).
- A significant association was found between the number of identified cost drivers and increased total inpatient costs.
- The developed methodology provided a more granular understanding of cost drivers than administrative data alone.
Conclusions:
- A novel method for analyzing high-cost pediatric inpatients was established, offering deeper insights into cost drivers.
- System errors and medical complications emerged as predominant factors contributing to high inpatient costs.
- Communication-related issues, including system errors and family communication, were frequently implicated in increased healthcare expenditures.
Objectives:
To delineate the drivers of cost associated with the most-costly inpatients in a tertiary pediatric hospital.
Methods:
We identified the 10% most-costly inpatients treated at a large regional children's hospital in 2010. From this group we randomly selected, within representative specialties, 2 groups of 50 inpatients for detailed chart review. By using daily cost data and clinical records, 2 independent reviewers examined the clinical course of each patient to identify events that drove cost beyond that expected for standard of care. By using an iterative process, these events were grouped into themes or "cost drivers." Linear regression was used to measure the association of number of cost drivers and total 2010 inpatient cost.
Results:
We identified 7 cost drivers: medical complications (49%), futile treatment (6%), failure to identify family care preferences (9%), system errors (65%), preventable admissions (21%), complex family dynamics (11%), and expensive diagnosis with no other cost driver (15%). Cost drivers were associated with increased total costs.
Conclusions:
We developed a novel method for understanding high-cost inpatients. This method allowed a more detailed understanding of cost drivers than could be achieved with administrative data alone. Many of these cost drivers were related to problems with communication.
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