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Postdischarge utilization of medical services by high-risk infants: experience in a large managed care organization
S Cavalier1, G J Escobar, S A Fernbach
1Department of Pediatrics, Kaiser Permanente Medical Center, Walnut Creek, California, USA.
Insights
High-risk infants (HRIs) show significantly higher hospitalization and outpatient visit rates compared to controls. Computerized data analysis offers a cost-effective method for tracking these vulnerable pediatric populations.
Area of Science:
- Pediatrics
- Health Services Research
- Neonatal Care
Background:
- Infants discharged from intensive care nurseries are identified as a high-risk infant (HRI) population with elevated medical service utilization.
- Traditional methods for tracking HRIs, such as chart review or direct patient contact, are costly and resource-intensive.
- Developing cost-effective methods to monitor HRI outcomes is crucial for efficient healthcare management.
Purpose of the Study:
- To establish a high-risk infant (HRI) cohort using defined criteria.
- To identify a comparable control group of infants not meeting HRI criteria.
- To quantify and compare inpatient and outpatient healthcare utilization between HRIs and controls using administrative data.
Main Methods:
- An HRI definition was established based on California Children's Services criteria.
- A cohort of 250 HRIs and 896 randomly selected controls was identified from a 1-year birth cohort at two neonatal intensive care units.
- Infant outcomes, including hospitalizations, hospital days, outpatient visits, and mortality, were tracked using computerized organizational files and state death certificate tapes until February 1992.
Main Results:
- The HRI group experienced a 6.07-fold higher hospitalization rate compared to the control group.
- Hospital day utilization was 13.24 times greater in the HRI population.
- Outpatient visit rates were also significantly higher in HRIs, showing a 1.40-fold increase.
Conclusions:
- Findings confirm significantly elevated hospitalization rates among HRIs, consistent with previous research.
- Outpatient healthcare utilization is also demonstrably higher in the HRI population.
- Utilizing computerized administrative files is a feasible and effective method for studying pediatric populations, supporting epidemiologic research, clinical trials, and resource allocation planning.
Background:
Infants discharged from intensive care nurseries are a high-risk infant (HRI) population known to have increased utilization of medical services. Most studies tracking HRIs have been based on data obtained from individual chart review or direct patient contact. Given the high cost of such studies, it is desirable to develop less costly methods to track such infants.
Objectives:
Our goals were: (1) to identify an HRI cohort at two neonatal intensive care units; (2) to identify a control group of infants not meeting HRI criteria; and (3) to measure outpatient and inpatient utilization in both controls using computerized files in a managed care organization.
Methods:
Using California Children's Services criteria as our starting point, we established an HRI definition. From a 1-year birth cohort of 7579 infants at two facilities, we identified 250 infants meeting the HRI definition at two neonatal intensive care units during 1990. We then matched the HRIs with a cohort of 896 randomly selected control newborns (those not meeting the HRI definition). Using organizational computer files and state of California death certificate tapes, we followed these infants until February 28, 1992. We measured the number of hospitalizations, total number of hospital days, and total number of outpatient visits and expressed these outcomes as rates per person-year. We also measured postdischarge mortality.
Results:
The rate of hospitalization in the HRI group was 6.07 times (95% confidence interval [CI], 4.74-7.77) that in the control group. The utilization of hospital days by the HRI population (hospital days per 1000 person-months) was 13.24 times higher (95% CI, 11.00-16.04). The outpatient visit rate was 1.40 times higher (95% CI, 1.36-1.45) in the HRI population.
Conclusion:
Our findings in a large managed care organization corroborate previous studies showing that hospitalization rates are significantly higher among HRIs. In our study population, outpatient utilization was significantly higher as well. Our study also demonstrates the feasibility of using computerized files to study outcomes in selected pediatric populations. These methods can be used for epidemiologic studies, interventional trials, and planning for resource allocation.