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Resource Use by Hospital Type for Frequent Inpatient Pediatric Conditions
Michelle A Lopez1,2, Xian Yu3, Annette Walder3
1Department of Pediatrics, and malopez@texaschildrens.org.
Insights
Children's hospitals (CHs) incur higher costs and longer stays for common pediatric conditions compared to non-CHs, even after accounting for patient and hospital factors. Further research is needed to understand these cost differences.
Area of Science:
- Pediatric Healthcare Research
- Health Services Research
- Hospital Resource Utilization
Background:
- Children's hospitals (CHs) specialize in complex pediatric cases, while non-CHs manage most common childhood illnesses.
- Understanding resource utilization across different hospital types for frequent pediatric conditions is crucial for healthcare policy and efficiency.
Purpose of the Study:
- To compare resource use, specifically length of stay (LOS) and total costs, for frequent inpatient pediatric conditions across different hospital types.
- To identify potential disparities in care delivery and cost-effectiveness between CHs and non-CHs for common pediatric conditions.
Main Methods:
- A cross-sectional, observational analysis using the 2016 Kids' Inpatient Database.
- Examined 8 frequent pediatric inpatient conditions, comparing freestanding CHs, non-CHs with teaching status (NCT), and non-CHs without teaching status.
- Multivariable linear regression was employed to control for patient and hospital factors influencing LOS and costs.
Main Results:
- Over 354,000 pediatric discharges for frequent conditions were analyzed.
- Non-CHs with teaching status (NCT) managed over half of these common pediatric cases.
- CHs demonstrated a 0.48% longer mean LOS and 61% higher costs compared to NCT hospitals, after adjusting for covariates (P < .01).
Conclusions:
- CHs incur significantly higher costs and longer lengths of stay for frequent pediatric conditions than NCT hospitals, even after controlling for patient and hospital factors.
- CHs manage patients with higher illness severity and medical complexity, raising questions about whether higher costs reflect justified specialized care.
- Further research is recommended to investigate potential unmeasured patient-level factors and the value of specialized care in CHs.
Background:
Children's hospitals (CHs) deliver care to underserved, critically ill, and medically complex patients. However, non-CHs care for the majority of children with frequently occurring conditions. In this study, we aimed to examine resource use across hospitals where children receive care for frequent inpatient conditions.
Methods:
This was a cross-sectional, observational analysis of pediatric hospitalizations for 8 frequent inpatient conditions (pneumonia, asthma, bronchiolitis, mood disorders, appendicitis, epilepsy, skin and soft tissue infections, and fluid and electrolyte disorders) in the 2016 Kids' Inpatient Database. Primary outcomes were median length of stay (LOS) and median total cost. The primary independent variable was hospital type: nonchildren's, nonteaching; nonchildren's, teaching (NCT); and freestanding CHs. Multivariable linear regression was used to assess differences in mean LOS and costs.
Results:
There were 354 456 pediatric discharges for frequent inpatient conditions. NCT hospitals cared for more than one-half of all frequent inpatient conditions. CHs and NCT hospitals cared for the majority of patients with higher illness severity and medical complexity. After controlling for patient and hospital factors, discharges for frequent inpatient conditions at CHs had 0.48% longer mean LOS and 61% greater costs compared with NCT hospitals (P < .01).
Conclusions:
CHs revealed higher estimated costs in caring for frequent inpatient conditions despite controlling for patient- and hospital-level factors but also cared for higher illness severity and medical complexity. Further research is warranted to explore whether we lack sufficient measures to control for patient-level factors and whether higher costs are justified by the specialized care at CHs.
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