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Does size matter? Hospital volume and resource use in paediatric diabetes care
Silvia A G de Vries1,2, Jessica C G Bak1,2, Dick Mul3
1Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Insights
Large hospitals had fewer hospitalizations for pediatric diabetes care. While technology use was similar across facilities, medium-sized centers incurred higher overall costs, though diabetes care expenses remained comparable regardless of hospital volume.
Area of Science:
- Pediatric Endocrinology
- Health Services Research
- Healthcare Management
Background:
- Paediatric diabetes care is increasingly specialized, requiring multidisciplinary teams and advanced technology.
- Guidelines emphasize the need for adequate experience within treatment teams for optimal patient outcomes.
- Hospital volume and resource allocation are critical factors influencing care quality and expenditure.
Purpose of the Study:
- To evaluate the association between hospital patient volume and resource utilization in Dutch children with diabetes.
- To analyze how hospital volume impacts hospital expenditure and care costs for pediatric diabetes management.
- To identify potential disparities in care provision based on hospital size and patient load.
Main Methods:
- A retrospective cohort study analyzed hospital claims data from 5082 children across 44 Dutch hospitals (2019-2020).
- Hospitals were categorized into small (20-100 patients), medium (100-200 patients), and large (≥200 patients) based on annual pediatric diabetes patient volume.
- Data on hospitalizations, consultations, technology use, and expenditure were adjusted for patient demographics and socio-economic status.
Main Results:
- Large hospitals demonstrated significantly lower all-cause hospitalization rates compared to small hospitals (OR 0.48).
- While median pediatrician visits were slightly higher in large hospitals, this difference was not statistically significant in multilevel analysis.
- Diabetes technology use, including insulin pump and real-time continuous glucose monitoring, showed no significant variation across hospital volume categories. Medium-sized hospitals had the highest mean overall expenditure (€6434 per patient).
Conclusions:
- Hospital patient volume influences care provision patterns in pediatric diabetes management.
- Larger hospitals are associated with reduced hospitalization rates, indicating potential efficiency gains.
- Despite variations in overall expenditure, diabetes-specific care costs did not significantly differ based on hospital volume, suggesting comparable quality of diabetes management across different-sized centers.
Aims:
Paediatric diabetes care has become increasingly specialised due to the multidisciplinary approach and technological developments. Guidelines recommend sufficient experience of treatment teams. This study evaluates associations between hospital volume and resource use and hospital expenditure in Dutch children with diabetes.
Methods:
Retrospective cohort study using hospital claims data of 5082 children treated across 44 Dutch hospitals (2019-2020). Hospitals were categorised into three categories; small (≥20-100 patients), medium (≥100-200 patients) and large (≥200 patients). All-cause hospitalisations, consultations, technology and hospital expenditure were analysed and adjusted for age, sex, socio-economic status (SES) and hospital of treatment.
Results:
Fewer hospitalisations were observed in large hospitals compared to small hospitals (OR 0.48; [95% CI 0.32-0.72]; p < 0.001). Median number of yearly paediatrician visits was 7 in large and 6 in small hospitals, the significance of which was attenuated in multilevel analysis (OR ≥7 consultations: 1.89; [95%CI 0.74-4.83]; p = 0.18). Technology use varies between individual hospitals, whereas pump usage and real-time continuous glucose monitoring showed no significant differences between hospital volumes. Mean overall expenditure was highest in medium-sized centres with €6434 per patient (IQR €2555-7955); the difference in diabetes care costs was not significant between hospital patient volumes.
Conclusions:
Care provision patterns vary by hospital patient volume. Large hospitals had the lowest hospitalisation rates. The use of diabetes technology was not different between hospital patient volumes. Medium-sized hospitals showed the highest overall expenditure, but diabetes care costs were similar across hospital volumes.
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