Published online August 31, 2005
PEDIATRICS Vol. 116 No. 3 September 2005, pp. 689-695 (doi:10.1542/peds.2004-2071)
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Factors Associated With Increased Resource Utilization for Congenital Heart Disease

Jean Anne Connor, DNSc, RN, CPNP, Kimberlee Gauvreau, ScD and Kathy J. Jenkins, MD, MPH

From the Department of Cardiology, Children’s Hospital, Boston, Massachusetts

Objective. To identify patient, institutional, and regional factors that are associated with high resource utilization for congenital heart surgery.

Methods. We used hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) year 2000 (data from 27 states). Patients who had congenital heart surgery and were younger than 18 years were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. High resource utilization admissions were defined as those in the highest decile for total hospital charges. Univariate and multivariate analyses with and without deaths were used to determine demographic and hospital predictors for cases of high resource use. Case-mix severity was approximated using Risk Adjustment for Congenital Heart Surgery risk groups. Regional and state differences were also examined.

Results. Among 10569 cases of congenital heart surgery identified, median total hospital charges were $53828. Statewide differences in the number of high resource use admissions were present; California, Colorado, Florida, Hawaii, Pennsylvania, and Texas were more likely to have high resource use cases, and Maine and South Carolina were less likely. Subsequent analyses were performed adjusting for baseline state effects. Multivariate analyses using generalized estimating equations models revealed Risk Adjustment for Congenital Heart Surgery risk category (odds ratio [OR]: 1.66–14.1), age (OR: 3.81), prematurity (OR: 4.85), the presence of other major noncardiac structural anomalies (OR: 2.53), Medicaid insurance (OR: 1.48), and admission during a weekend (OR: 1.62) to be independent predictors of a higher odds of high cost cases. Although some institutional differences were noted in univariate analyses, gender, race, bed size, teaching and children’s hospital status, hospital ownership, and hospital volume of cardiac cases were not independently associated with greater odds of high resource utilization.

Conclusions. States varied in the frequency of high resource utilization for congenital heart surgery. Patients who had greater disease complexity, younger age, prematurity, other anomalies, and Medicaid and were admitted during a weekend were more likely to result in high resource utilization. Institutions of various types did not differ in high cost admissions, regardless of children’s hospital or teaching status.

Key Words: congenital heart disease • Kids’ Inpatient Database • resource utilization • hospital charges • risk adjustment

Abbreviations: HCUP, Healthcare Cost and Utilization Project • KID, Kids’ Inpatient Database • SID, State Inpatient Database • ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification • RACHS-1, Risk Adjustment for Congenital Heart Surgery • ROC, receiver operating characteristic • OR, odds ratio • CI, confidence interval

Accepted Dec 29, 2004.


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