COMPARATIVE STUDY
JOURNAL ARTICLE

Lengths of stay and costs associated with children's hospitals

Dan Merenstein, Brian Egleston, Marie Diener-West
Pediatrics 2005, 115 (4): 839-44
15805353

OBJECTIVE: Because of the unique mission of freestanding children's hospitals, higher costs have generally been accepted; however, increasing health care costs and the impetus for outcomes data demand more accountability. For common diagnoses, with respect to quality care indicators, length of stay (LOS), and total charges, we propose to compare freestanding children's hospitals and other hospitals. Our hypothesis is that, for similar diagnoses, freestanding children hospitals will have longer LOSs and higher costs than other hospitals.

METHODS: Data were analyzed from the Healthcare Cost and Utilization Project Kids' Inpatient Database 2000. Encounters qualified for evaluation when 1 of the top 3 discharge codes was consistent with pneumonia, gastroenteritis, respiratory syncytial virus, dehydration, or asthma. Our outcomes were LOS and total charges per hospital admission; hospitals were categorized as children's hospitals and nonchildren's hospitals. We adjusted for the following potential confounders: number of diagnoses, insurance information, patient age in years, race of patient, admission source, procedures, teaching status of hospital, and hospital location. Because of the right skew of the outcomes, our primary analyses consisted of robust median regression; to support our final models, we also performed sensitivity analyses.

RESULTS: Of 252262 total inpatient encounters, 24322 met the inclusion criteria. There were 3408 encounters from 23 different freestanding children's hospitals and 20914 encounters from 1749 nonchildren's hospitals. Freestanding children's hospitals provided care to a higher risk population with more children transferred from other hospitals, a higher percentage of minorities, increased number of co-diagnoses, and a higher percentage on Medicaid. There was no statistically significant difference in LOS by hospital type. However, there was a significant difference in total costs, with the median cost of an admission at freestanding children's hospitals 1294 dollars more per hospitalization than at nonchildren's hospitals, after adjusting for confounders.

CONCLUSION: We found no significant difference in median LOS among freestanding children's hospitals and nonchildren's hospitals, but freestanding children's hospitals had higher total charges per admission, even after adjusting for differences in population characteristics. Additional studies are needed to elucidate whether these increased costs result in better health outcomes or are simply attributable to other characteristics of children's hospitals, in which not all patients may benefit.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
15805353
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"