Kimberly E McHugh1, William T Mahle2, Matthew A Hall3, Mark A Scheurer4, Michael-Alice Moga5, John Triedman6, Susan C Nicolson7, Venugopal Amula8, David S Cooper9, Marcus Schamberger10, Michael Wolf2, Lara Shekerdemian11, Kristin M Burns12, Kathleen E Ash13, Dustin M Hipp11, Sara K Pasquali13. 1. Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina. Electronic address: mchughke@musc.edu. 2. Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia. 3. Children's Hospital Association, Lenexa, Kansas. 4. Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina. 5. Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. 6. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts. 7. Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania. 8. Department of Pediatrics, University of Utah, Salt Lake City, Utah. 9. Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 10. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana. 11. Department of Critical Care, Texas Children's Hospital, Houston, Texas. 12. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. 13. Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan.
Abstract
BACKGROUND: The Pediatric Heart Network Collaborative Learning Study (PHN CLS) increased early extubation rates after infant tetralogy of Fallot (TOF) and coarctation of the aorta (CoA) repair across participating sites by implementing a clinical practice guideline (CPG). The impact of the CPG on hospital costs has not been studied. METHODS: PHN CLS clinical data were linked to cost data from Children's Hospital Association by matching on indirect identifiers. Hospital costs were evaluated across active and control sites in the pre- and post-CPG periods using generalized linear mixed-effects models. A difference-in-difference approach was used to assess whether changes in cost observed in active sites were beyond secular trends in control sites. RESULTS: Data were successfully linked on 410 of 428 eligible patients (96%) from four active and four control sites. Mean adjusted cost per case for TOF repair was significantly reduced in the post-CPG period at active sites ($42,833 vs $56,304, p < 0.01) and unchanged at control sites ($47,007 vs $46,476, p = 0.91), with an overall cost reduction of 27% in active versus control sites (p = 0.03). Specific categories of cost reduced in the TOF cohort included clinical (-66%, p < 0.01), pharmacy (-46%, p = 0.04), lab (-44%, p < 0.01), and imaging (-32%, p < 0.01). There was no change in costs for CoA repair at active or control sites. CONCLUSIONS: The early extubation CPG was associated with a reduction in hospital costs for infants undergoing repair of TOF but not CoA. This CPG represents an opportunity to both optimize clinical outcome and reduce costs for certain infant cardiac surgeries.
BACKGROUND: The Pediatric Heart Network Collaborative Learning Study (PHNCLS) increased early extubation rates after infant tetralogy of Fallot (TOF) and coarctation of the aorta (CoA) repair across participating sites by implementing a clinical practice guideline (CPG). The impact of the CPG on hospital costs has not been studied. METHODS:PHNCLS clinical data were linked to cost data from Children's Hospital Association by matching on indirect identifiers. Hospital costs were evaluated across active and control sites in the pre- and post-CPG periods using generalized linear mixed-effects models. A difference-in-difference approach was used to assess whether changes in cost observed in active sites were beyond secular trends in control sites. RESULTS: Data were successfully linked on 410 of 428 eligible patients (96%) from four active and four control sites. Mean adjusted cost per case for TOF repair was significantly reduced in the post-CPG period at active sites ($42,833 vs $56,304, p < 0.01) and unchanged at control sites ($47,007 vs $46,476, p = 0.91), with an overall cost reduction of 27% in active versus control sites (p = 0.03). Specific categories of cost reduced in the TOF cohort included clinical (-66%, p < 0.01), pharmacy (-46%, p = 0.04), lab (-44%, p < 0.01), and imaging (-32%, p < 0.01). There was no change in costs for CoA repair at active or control sites. CONCLUSIONS: The early extubation CPG was associated with a reduction in hospital costs for infants undergoing repair of TOF but not CoA. This CPG represents an opportunity to both optimize clinical outcome and reduce costs for certain infant cardiac surgeries.
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