Regional Variation in Standardized Costs of Care at Children’s Hospitals

Jonas, Jennifer A.; Shah, Samir S.; Zaniletti, Isabella; Hall, Matthew; Colvin, Jeffrey D.; Gottlieb, Laura M.; Sills, Marion R.; Bettenhausen, Jessica L.; Morse, Rustin B.; Macy, Michelle L.; Fieldston, Evan S.

doi:10.12788/jhm.2829

Cited by 12 publications

(11 citation statements)

References 27 publications

(32 reference statements)

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“…16 The conditionspecific variation in cost across hospitals was adjusted for known factors associated with variation in cost, including age, sex, number of CCCs present, material deprivation, and rural vs urban classification to minimize confounding from other factors that may have biased the extent of variation in cost across hospitals. 16,[34][35][36] To alleviate skewness, hospital encounter costs were log transformed before conducting the analysis of variation in cost. The variation in cost per encounter was assessed using 2 methods 16 : intraclass correlation coefficient (ICC) and number of outlier hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…We focused on the conditions with the highest cumulative cost because they would either be highly prevalent or highly costly per encounter . The condition-specific variation in cost across hospitals was adjusted for known factors associated with variation in cost, including age, sex, number of CCCs present, material deprivation, and rural vs urban classification to minimize confounding from other factors that may have biased the extent of variation in cost across hospitals …”

Section: Methodsmentioning

confidence: 99%

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Prevalence, Cost, and Variation in Cost of Pediatric Hospitalizations in Ontario, Canada

et al. 2022

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IMPORTANCEIdentifying conditions that could be prioritized for research based on health care system burden is important for developing a research agenda for the care of hospitalized children.However, existing prioritization studies are decades old or do not include data from both pediatric and general hospitals. OBJECTIVE To assess the prevalence, cost, and variation in cost of pediatric hospitalizations at all general and pediatric hospitals in Ontario, Canada, with the aim of identifying conditions that could be prioritized for future research. DESIGN, SETTING, AND PARTICIPANTSThis population-based cross-sectional study used health administrative data from 165 general and pediatric hospitals in Ontario, Canada. Children younger than 18 years with an inpatient hospital encounter between April 1, 2014, and March 31, 2019, were included. MAIN OUTCOMES AND MEASURESCondition-specific prevalence, cost of pediatric hospitalizations, and condition-specific variation in cost per inpatient encounter across hospitals.Variation in cost was evaluated using (1) intraclass correlation coefficient (ICC) and (2) number of outlier hospitals. Costs were adjusted for inflation to 2018 US dollars. RESULTSOverall, 627 314 inpatient hospital encounters (44.8% among children younger than 30 days and 53.0% among boys) at 165 hospitals (157 general and 8 pediatric) costing $3.3 billion were identified. A total of 408 003 hospitalizations (65.0%) and $1.4 billion (43.8%) in total costs occurred at general hospitals. Among the 50 most prevalent and 50 most costly conditions (of 68 total conditions), the top 10 highest-cost conditions accounted for 55.5% of all costs and 48.6% of all encounters. The conditions with highest prevalence and cost included low birth weight (86.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prevalence, Cost, and Variation in Cost of Pediatric Hospitalizations in Ontario, Canada

et al. 2022

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“…The condition-specific variation in cost across hospitals was adjusted for known drivers of variation in cost to minimize confounding from other factors that may bias the magnitude of variation in cost per encounter across hospitals. 6,[23][24][25] These included age, sex, race/ethnicity, patient type, and number of CCCs present (0, 1, 2, or Ն3). Rural-Urban Commuting Area, primary payer, and income were not included owing to high multicollinearity.…”

Section: Discussionmentioning

confidence: 99%

“…We then determined the variation in cost of hospitalization by condition for the 50 most prevalent and 50 most costly conditions, focusing on their cost per encounter, across hospitals. The condition-specific variation in cost across hospitals was adjusted for known drivers of variation in cost to minimize confounding from other factors that may bias the magnitude of variation in cost per encounter across hospitals . These included age, sex, race/ethnicity, patient type, and number of CCCs present (0, 1, 2, or ≥3).…”

Section: Methodsmentioning

confidence: 99%

Identifying Conditions With High Prevalence, Cost, and Variation in Cost in US Children’s Hospitals

et al. 2021

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IMPORTANCE Identifying high priority pediatric conditions is important for setting a research agenda in hospital pediatrics that will benefit families, clinicians, and the health care system.However, the last such prioritization study was conducted more than a decade ago and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.OBJECTIVES To identify conditions that should be prioritized for comparative effectiveness research based on prevalence, cost, and variation in cost of hospitalizations using contemporary data at US children's hospitals. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study of children with hospital encounters used data from the Pediatric Health Information System database. Children younger than 18 years with inpatient hospital encounters at 45 tertiary care US children's hospitals between

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“…However, these were costs for all DKA admissions. Costs for children, as with the UK data, were calculated as being lower than those for adults at between $7429 (£5642) and $10 881 (£8264) [20]. Data from Germany did not give estimates of cost per episode, but showed that annual care costs for individuals who had FIGURE 2 A log-normal distribution best fit the imputed total costs ª 2019 Diabetes UK episodes of DKA were increased compared with those who did notcost ratio of 2.2 (95% CI 2.1 to 2.3) for those with just one episode of DKA and 3.6 (95% CI 3.1 to 4.1) for those with more than one episode [16].…”

Section: Discussionmentioning

confidence: 99%

The cost of treating diabetic ketoacidosis in an adolescent population in the UK: a national survey of hospital resource use

et al. 2019

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Aims Adolescents with Type 1 diabetes commonly experience episodes of ketoacidosis. In 2014, we conducted a nationwide survey on the management of diabetic ketoacidosis in young people. The survey reported how individual adolescents with diabetes were managed. However, the costs of treating diabetic ketoacidosis were not reported. Methods Using this mixed population sample of adolescents, we took a ‘bottom‐up’ approach to cost analysis aiming to determine the total expense associated with treating diabetic ketoacidosis. The data were derived using the information from the national UK survey of 71 individuals, collected via questionnaires sent to specialist paediatric diabetes services in England and Wales. Results Several assumptions had to be made when analysing the data because the initial survey collection tool was not designed with a health economic model in mind. The mean time to resolution of diabetic ketoacidosis was 15.0 h [95% confidence interval (CI) 13.2, 16.8] and the mean total length of stay was 2.4 days (95% CI 1.9, 3.0). Based on data for individuals and using the British Society of Paediatric Endocrinology and Diabetes (BSPED) guidelines, the cost analysis shows that for this cohort, the average cost for an episode of diabetic ketoacidosis was £1387 (95% CI 1120, 1653). Regression analysis showed a significant cost saving of £762 (95% CI 140, 1574; P = 0.04) among those treated using BSPED guidelines. Conclusion We have used a bottom‐up approach to calculate the costs of an episode of diabetic ketoacidosis in adolescents. These data suggest that following treatment guidelines can significantly lower the costs for managing episodes of diabetic ketoacidosis.

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Regional Variation in Standardized Costs of Care at Children’s Hospitals

Cited by 12 publications

References 27 publications

Prevalence, Cost, and Variation in Cost of Pediatric Hospitalizations in Ontario, Canada

Prevalence, Cost, and Variation in Cost of Pediatric Hospitalizations in Ontario, Canada

Identifying Conditions With High Prevalence, Cost, and Variation in Cost in US Children’s Hospitals

The cost of treating diabetic ketoacidosis in an adolescent population in the UK: a national survey of hospital resource use

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