Published online April 1, 2005
PEDIATRICS Vol. 115 No. 4 April 2005, pp. 839-844 (doi:10.1542/peds.2004-1622)
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Lengths of Stay and Costs Associated With Children's Hospitals

Dan Merenstein, MD*, Brian Egleston, MPP{ddagger} and Marie Diener-West, PhD{ddagger}

* Johns Hopkins School of Medicine, Baltimore, Maryland
{ddagger} Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

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 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.

Key Words: hospital performance • length of stay

Abbreviations: NACHRI, National Association of Children's Hospitals and Related Institutions • HCUP, Healthcare Cost and Utilization Project • The KID, Kids' Inpatient Database 2000 • AHRQ, Agency for Healthcare Research and Quality • ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modifications • CI, confidence interval

Accepted Sep 1, 2004.




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