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Financial, Resource Utilization and Mortality Impacts of Teaching Hospital Status on Pediatric Patients Admitted for
Benson S Hsu1, Benjamin D Meyer, Saquib A Lakhani
1From the Division of Critical Care Medicine, Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota.
Insights
Pediatric sepsis care in teaching hospitals involves higher costs and resource use compared to nonteaching facilities. This study found no significant difference in mortality rates, suggesting potential inefficiencies in teaching hospital sepsis management.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Hospital administration
Background:
- Teaching hospitals face dual pressures of medical education and cost-effective care.
- Pediatric sepsis management presents unique challenges within the evolving US healthcare system.
Purpose of the Study:
- To investigate the financial, resource utilization, and mortality impact of teaching hospital status on pediatric sepsis admissions.
- To compare sepsis care outcomes between teaching and nonteaching hospitals for pediatric patients.
Main Methods:
- Retrospective analysis of the 2009 Kids' Inpatient Database.
- Weighted statistical analysis of 17,461 pediatric sepsis cases.
- Comparison of outcomes based on teaching hospital status, including length of stay, procedures, mortality, and costs.
Main Results:
- Teaching hospitals had significantly longer lengths of stay (8.2 vs. 4.8 days) and more procedures (2.03 vs. 0.87) for pediatric sepsis patients.
- Overall mortality was higher in teaching hospitals (4.7% vs. 1.6%), but this difference was not observed when stratified by severity.
- Costs per day ($2326 vs. $1736) and total costs ($20,428 vs. $7960) were substantially higher in teaching hospitals.
Conclusions:
- Pediatric sepsis care in teaching hospitals is associated with increased costs and resource utilization.
- Despite higher resource allocation, teaching hospitals did not demonstrate improved overall mortality rates for pediatric sepsis patients compared to nonteaching hospitals.
- Findings suggest a need to evaluate efficiency and cost-effectiveness in pediatric sepsis management within teaching hospital settings.
Background:
With the changing healthcare landscape in the United States, teaching hospitals face increasing pressure to provide medical education as well as cost-effective care. Our study investigated the financial, resource utilization and mortality impact of teaching hospital status on pediatric patients admitted with sepsis.
Methods:
We conducted a retrospective, weighted statistical analysis of hospitalized children with the diagnosis of sepsis. The Agency for Healthcare Research and Quality 2009 Kids' Inpatient Database provided the data for analysis. Diagnosis of sepsis and severity of illness levels were based on All Patient Refined Diagnosis-Related Groups of 720: Septicemia and Disseminated Infections. Teaching hospital status was based on presence of training programs. Statistical analysis was conducted using STATA 12.1 (Stata Corporation, College Station, TX).
Results:
Weighted analysis revealed 17,461 patients with sepsis-9982 in teaching and 7479 in nonteaching hospitals. When comparing all patients, length of stay (8.2 vs. 4.8, P < 0.001), number of procedures received (2.03 vs. 0.87, P < 0.001), mortality (4.7% vs. 1.6%, P < 0.001), costs per day ($2326 vs. $1736, P < 0.001) and total costs ($20,428 vs. $7960, P < 0.001) were higher in teaching hospitals. Even when stratified by severity classes, length of stay, number of procedures received and total costs were higher in teaching hospitals with no difference in mortality.
Conclusions:
Our study suggested that teaching hospitals provide pediatric inpatient care for sepsis at greater costs and resource utilization without a clear improvement in overall mortality rates in comparison with nonteaching hospitals.
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