An N Massaro1, Karna Murthy2, Isabella Zaniletti3, Noah Cook4, Robert DiGeronimo5, Maria L V Dizon6, Shannon E G Hamrick7, Victor J McKay8, Girija Natarajan9, Rakesh Rao10, Troy Richardson3, Danielle Smith11, Amit M Mathur10. 1. Children's National Health System and the Department of Pediatrics, George Washington University School of Medicine, Washington, DC. Electronic address: anguyenm@childrensnational.org. 2. Ann and Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Children's Hospitals Neonatal Consortium, Inc. 3. Children's Hospitals Association, Overland Park, KS. 4. Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 5. Department of Pediatrics, University of Utah and the Primary Children's Medical Center, Salt Lake City, UT. 6. Ann and Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL. 7. Department of Pediatrics and Children's Healthcare of Atlanta at Egleston, Emory University, Atlanta, GA. 8. All Children's Hospital, St Petersburg, FL. 9. Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI. 10. Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO. 11. Children's Hospital of Colorado and Department of Pediatrics, University of Colorado, Aurora, CO.
Abstract
OBJECTIVE: To quantify intercenter cost variation for perinatal hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals. STUDY DESIGN: Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes. RESULTS: Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86%) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29% of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs. CONCLUSIONS: There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.
OBJECTIVE: To quantify intercenter cost variation for perinatal hypoxic ischemicencephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals. STUDY DESIGN: Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes. RESULTS: Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86%) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29% of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs. CONCLUSIONS: There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.
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Authors: Maria L V Dizon; Rakesh Rao; Shannon E Hamrick; Isabella Zaniletti; Robert DiGeronimo; Girija Natarajan; Jeffrey R Kaiser; John Flibotte; Kyong-Soon Lee; Danielle Smith; Toby Yanowitz; Amit M Mathur; An N Massaro Journal: BMC Pediatr Date: 2019-02-27 Impact factor: 2.125