Nursing intensity scores did not correlate well with reimbursement claims for infant bronchiolitis
Paula Heikkilä1, Petra Kokko2, Olli Lohi1
1Centre for Child Health Research, Tampere University and University Hospital, Tampere, Finland.
Insights
Hospital reimbursement for infant bronchiolitis treatment, particularly in the pediatric intensive care unit (PICU), was significantly higher than ward care. Reimbursement rates did not align with nursing intensity scores, indicating a potential disparity in resource allocation for pediatric respiratory illness.
Area of Science:
- Pediatrics
- Healthcare Economics
- Nursing Science
Background:
- Bronchiolitis is a common respiratory infection in infants, often requiring hospitalization.
- Accurate assessment of patient acuity and resource utilization is crucial for effective healthcare management.
- Nursing intensity scores aim to quantify patient care needs, influencing resource allocation and reimbursement.
Purpose of the Study:
- To retrospectively evaluate hospital reimbursement rates for inpatient bronchiolitis treatment.
- To compare these reimbursement rates with the RAFAELA® nursing intensity scores.
- To assess the alignment between financial claims and actual nursing care requirements in pediatric bronchiolitis cases.
Main Methods:
- Retrospective analysis of 44 pediatric intensive care unit (PICU) and 88 ward-admitted bronchiolitis patients (under 12 months) from 2010-2015.
- Data collection included medical histories, hospital reimbursement data (Nordic Diagnosis Related Groups or expense categories), and RAFAELA® scores.
- Comparison of reimbursement rates and nursing intensity scores between PICU and ward admissions.
Main Results:
- Reimbursement claims were primarily based on expense categories for PICU and NordDRG for ward admissions.
- Median reimbursement per episode was €6352 for PICU and €2009 for ward cases, with a median length of stay of 8.5 and 3 days, respectively.
- Higher RAFAELA® scores correlated with specific therapies (e.g., CPAP, ventilation, oxygen, NG tube feeding), but overall correlation coefficients with reimbursement ranged from 0.121-0.450.
Conclusions:
- Hospital reimbursement for PICU admissions for bronchiolitis was three times higher than for ward admissions.
- Current hospital reimbursement claims for bronchiolitis do not accurately reflect nursing intensity scores.
- There is a notable discrepancy between financial reimbursement and the assessed nursing care needs in pediatric bronchiolitis management.
Aim:
We retrospectively evaluated the hospital reimbursement rates for inpatient bronchiolitis treatment and then compared them to the RAFAELA® nursing intensity scores.
Methods:
We selected all 44 bronchiolitis patients treated in the paediatric intensive care unit (PICU) and then for each PICU-treated patient two patients treated on the ward (n = 88) under 12 months of age in 2010-2015. The data included medical histories, hospital reimbursement rates using the Nordic Diagnosis Related Groups (NordDRG) or expense categories and the RAFAELA® scores.
Results:
Reimbursement claims were mostly based on expense categories for PICU admissions and NordDRG categories for ward admissions. The median (range) was €6352 (€1330-30 554) and €2009 (€768-6027) per episode for the PICU and ward cases, respectively. The median lengths of hospital stay were 8.5 days (3-18) and 3 days (1-8), respectively. Higher RAFAELA® scores were associated with nasal continuous positive airway pressure therapy and mechanical ventilation in the PICU and oxygen supplementation and nasogastric tube feeding on the ward. The correlation coefficients between RAFAELA® scores and hospital reimbursement claims ranged from 0.121-0.450.
Conclusion:
Hospital reimbursement claim for a PICU admission was three times as much as a ward admission and reimbursement claims for bronchiolitis did not match with nursing intensity scores.
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