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Hospitals' Diversity of Diagnosis Groups and Associated Costs of Care
Jay G Berry1,2, Matt Hall3,4, Eyal Cohen5,6
1Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; jay.berry@childrens.harvard.edu.
Insights
Hospitals with more diverse diagnoses incur higher costs per child hospitalization. Considering diagnosis diversity is crucial for understanding pediatric inpatient care expenses.
Area of Science:
- Pediatric Healthcare Economics
- Hospital Cost Analysis
- Health Services Research
Background:
- Hospitals with a wider range of patient diagnoses may face increased fixed and overhead expenses.
- Understanding the relationship between hospital diagnosis diversity and cost is essential for financial planning in pediatric care.
Purpose of the Study:
- To assess the association between hospital diagnosis diversity and the cost per hospitalization for pediatric patients.
- To determine if diagnosis diversity influences cost differences across various hospital types.
Main Methods:
- Retrospective analysis of over 1.6 million pediatric hospitalizations (ages 0-21) from the 2016 Kids' Inpatient Database.
- Calculation of the Hospital Diagnosis Diversity Index (HDDI) using Shannon-Wiener entropy.
- Multivariable log-normal models were used to analyze the relationship between HDDI, hospital type, and cost per hospitalization, adjusting for patient and hospital characteristics.
Main Results:
- Freestanding Children's Hospitals (FCHs) and Non-Freestanding Children's Hospitals (NFCHs) had significantly higher HDDI than Non-Children's Hospitals (NCHs).
- A greater HDDI was significantly associated with increased mean cost per hospitalization across all hospitals.
- After adjusting for HDDI, the cost differences between hospital types became nonsignificant.
Conclusions:
- Increased diagnosis diversity in hospitals is linked to higher costs per hospitalization for pediatric patients.
- Hospital diagnosis diversity is a key factor to consider when evaluating the costs of inpatient pediatric care.
Background And Objectives:
Hospitals treating patients with greater diagnosis diversity may have higher fixed and overhead costs. We assessed the relationship between hospitals' diagnosis diversity and cost per hospitalization for children.
Methods:
Retrospective analysis of 1 654 869 all-condition hospitalizations for children ages 0 to 21 years from 2816 hospitals in the Kids' Inpatient Database 2016. Mean hospital cost per hospitalization, Winsorized and log-transformed, was assessed for freestanding children's hospitals (FCHs), nonfreestanding children's hospitals (NFCHs), and nonchildren's hospitals (NCHs). Hospital diagnosis diversity index (HDDI) was calculated by using the D-measure of diversity in Shannon-Wiener entropy index from 1254 diagnosis and severity-of-illness groups distinguished with 3M Health's All Patient Refined Diagnosis Related Groups. Log-normal multivariable models were derived to regress hospital type on cost per hospitalization, adjusting for hospital-level HDDI in addition to patient-level demographic (eg, age, race and ethnicity) and clinical (eg, chronic conditions) characteristics and hospital teaching status.
Results:
Admission counts were 383 789 (23.2%) in FCHs, 588 463 (35.6%) in NFCHs, and 682 617 (41.2%) in NCHs. Unadjusted mean cost per hospitalization was $10 757 (95% confidence interval [CI]: $9451 to $12 243) in FCHs, $6264 (95% CI: $5830 to $6729) in NFCHs, and $4192 (95% CI: $4121 to $4265) in NCHs. HDDI was significantly (P < .001) higher in FCHs and NFCHs (median 9.2 and 6.4 times higher, respectively) than NCHs. Across all hospitals, greater HDDI was associated (P = .002) with increased cost. Adjusting for HDDI resulted in a nonsignificant (P = .1) difference in cost across hospital types.
Conclusions:
Greater diagnosis diversity was associated with increased cost per hospitalization and should be considered when assessing associated costs of inpatient care for pediatric patients.
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