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Sabapathy DG, Hosek K, Lam FW, Desai MS, Williams EA, Goss J, Raphael JL, Lopez MA. Identifying drivers of cost in pediatric liver transplantation. Liver Transpl 2024:01445473-990000000-00349. [PMID: 38535617 DOI: 10.1097/lvt.0000000000000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/13/2024] [Indexed: 05/09/2024]
Abstract
Understanding the economics of pediatric liver transplantation (LT) is central to high-value care initiatives. We examined cost and resource utilization in pediatric LT nationally to identify drivers of cost and hospital factors associated with greater total cost of care. We reviewed 3295 children (<21 y) receiving an LT from 2010 to 2020 in the Pediatric Health Information System to study cost, both per LT and service line, and associated mortality, complications, and resource utilization. To facilitate comparisons, patients were stratified into high-cost, intermediate-cost, or low-cost tertiles based on LT cost. The median cost per LT was $150,836 [IQR $104,481-$250,129], with marked variance in cost within and between hospital tertiles. High-cost hospitals (HCHs) cared for more patients with the highest severity of illness and mortality risk levels (67% and 29%, respectively), compared to intermediate-cost (60%, 21%; p <0.001) and low-cost (51%, 16%; p <0.001) hospitals. Patients at HCHs experienced a higher prevalence of mechanical ventilation, total parental nutrition use, renal comorbidities, and surgical complications than other tertiles. Clinical (27.5%), laboratory (15.1%), and pharmacy (11.9%) service lines contributed most to the total cost. Renal comorbidities ($69,563) and total parental nutrition use ($33,192) were large, independent contributors to total cost, irrespective of the cost tertile ( p <0.001). There exists a significant variation in pediatric LT cost, with HCHs caring for more patients with higher illness acuity and resource needs. Studies are needed to examine drivers of cost and associated outcomes more granularly, with the goal of defining value and standardizing care. Such efforts may uniquely benefit the sicker patients requiring the strategic resources located within HCHs to achieve the best outcomes.
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Affiliation(s)
- Divya G Sabapathy
- Department of Pediatrics, Baylor College of Medicine, Division of Critical Care Medicine, Houston, Texas, USA
| | - Kathleen Hosek
- Texas Children's Hospital, Department of Quality, Houston, Texas, USA
| | - Fong W Lam
- Department of Pediatrics, Baylor College of Medicine, Division of Critical Care Medicine, Houston, Texas, USA
| | - Moreshwar S Desai
- Department of Pediatrics, Baylor College of Medicine, Division of Critical Care Medicine, Houston, Texas, USA
| | - Eric A Williams
- Department of Pediatrics, Division of Critical Care Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - John Goss
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Center for Child Health Policy and Advocacy, Houston, TX, USA
| | - Michelle A Lopez
- Center for Child Health Policy and Advocacy, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Division of Hospital Medicine, Houston, Texas, USA
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2
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Madden K, Wolf M, Tasker RC, Figueroa J, McCracken C, Hall M, Kamat P. Antipsychotic Drug Prescription in Pediatric Intensive Care Units: A 10-Year U.S. Retrospective Database Study. J Pediatr Intensive Care 2024; 13:46-54. [PMID: 38571986 PMCID: PMC10987219 DOI: 10.1055/s-0041-1736523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022] Open
Abstract
Delirium recognition during pediatric critical illness may result in the prescription of antipsychotic medication. These medications have unclear efficacy and safety. We sought to describe antipsychotic medication use in pediatric intensive care units (PICUs) contributing to a U.S. national database. This study is an analysis of the Pediatric Health Information System Database between 2008 and 2018, including children admitted to a PICU aged 0 to 18 years, without prior psychiatric diagnoses. Antipsychotics were given in 16,465 (2.3%) of 706,635 PICU admissions at 30 hospitals. Risperidone (39.6%), quetiapine (22.1%), and haloperidol (20.8%) were the most commonly used medications. Median duration of prescription was 4 days (interquartile range: 2-11 days) for atypical antipsychotics, and haloperidol was used a median of 1 day (1-3 days). Trend analysis showed quetiapine use increased over the study period, whereas use of haloperidol and chlorpromazine (typical antipsychotics) decreased ( p < 0.001). Compared with no antipsychotic administration, use of antipsychotics was associated with comorbidities (81 vs. 65%), mechanical ventilation (57 vs. 36%), longer PICU stay (6 vs. 3 days), and higher mortality (5.7 vs. 2.8%) in univariate analyses. In the multivariable model including demographic and clinical factors, antipsychotic prescription was associated with mortality (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.02-1.18). Use of atypical antipsychotics increased over the 10-year period, possibly reflecting increased comfort with their use in pediatric patients. Antipsychotics were more common in patients with comorbidities, mechanical ventilation, and longer PICU stay, and associated with higher mortality in an adjusted model which warrants further study.
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Affiliation(s)
- Kate Madden
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Michael Wolf
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Robert C. Tasker
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, United States
| | - Pradip Kamat
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
- Division of Critical Care, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, United States
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3
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Andoh AA, Lo CB, Shi J, Bode RS, Gee SW, Leonard JC. Cost analysis of hospitals performing continuous albuterol in non-intensive care settings. J Asthma 2023; 60:314-322. [PMID: 35238716 DOI: 10.1080/02770903.2022.2047717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare hospital costs and resource utilization for pediatric asthma admissions based on the hospitals' availability of continuous albuterol aerosolization administration (CAA) in non-intensive care unit (ICU) settings. METHODS We conducted a retrospective cohort study of children ages 2-17 years admitted in 2019 with a principal diagnosis of asthma using the Pediatric Health Information System. Hospitals and hospitalizations were categorized based on location of CAA administration, ICU-only versus general inpatient floors. Hospitals preforming CAA in an intermediate care unit were excluded. We calculated total cost, standardized unit costs and rates of interventions. Groups were compared using Chi-Square, t-test and Wilcoxon rank-sum test as indicated. A log linear mixed model was created to evaluate potential confounders. RESULTS Twenty-one hospitals (7084 hospitalizations) allowed CAA on the floor.Twenty-four hospitals (6100 hospitalizations) allowed CAA in the ICU-only. Median total cost was $4639 (Interquartile Range (IQR) $3060-$7512) for the floor group and $5478 (IQR $3444-$8539) for the ICU-only group (p < 0.001) (mean cost difference of $775 per patient). Hospitalization costs were $4,726,829 (95% CI $3,459,920-$5,993,860) greater for the children treated at hospitals restricting CAA to the ICU. We observed higher standardized laboratory, imaging, clinical and other unit costs, along with higher use of interventions in the ICU-only group. After adjustment, we found that ICU stay and hospital LOS were the main drivers of cost difference between the groups. CONCLUSIONS There was cost savings and decreased resource utilization for hospitals that performed CAA on the floor. Further studies exploring variations in asthma management are warranted.
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Affiliation(s)
- Adjoa A Andoh
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.,The Ohio State University College of Medicine, Columbus, Ohio
| | - Charmaine B Lo
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Junxin Shi
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Biostatistical Resource, Columbus, OH
| | - Ryan S Bode
- The Ohio State University College of Medicine, Columbus, Ohio.,Division of Hospital Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Samantha W Gee
- The Ohio State University College of Medicine, Columbus, Ohio.,Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Julie C Leonard
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.,The Ohio State University College of Medicine, Columbus, Ohio.,Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH
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4
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Hartley J, Bettenhausen J, Hall M, Synhorst D, Gay J. Financial outcomes of high-flow nasal cannula use for bronchiolitis on the general pediatric floor. J Hosp Med 2023; 18:55-58. [PMID: 36349987 DOI: 10.1002/jhm.12994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/29/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
High-flow nasal cannula (HFNC) is an increasingly common treatment utilized for bronchiolitis on general pediatric hospital floors. This could present a financial burden for hospitals if reimbursement has not accounted for the increased costs associated with increased HFNC use. Pediatric Health Information System and Revenue Management Program data set discharges from 2018 to 2019 were utilized to calculate the ratio of reimbursements to costs as a cost coverage ratio (CCR). The CCR was compared by HFNC use, the severity of illness, and payor type. The CCR was highest at 1.68 for children with high severity and HFNC use but varied greatly by payor. The lowest CCR at 0.77 was seen for children with low severity and public insurance and indicated potential financial losses for these patients. This was lower than low-severity patients on HFNC with private payors (1.68) and high-severity patients on HFNC with public payors (1.18).
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Affiliation(s)
- Jonathan Hartley
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Jessica Bettenhausen
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Matt Hall
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri, USA
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Dave Synhorst
- Division of Pediatric Hospital Medicine, College of Medicine, Helen DeVos Children's Hospital, Michigan State University, Grand Rapids, Michigan, USA
| | - James Gay
- Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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5
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Ramgopal S, Lorenz D, Ambroggio L, Navanandan N, Cotter JM, Florin TA. Identifying Potentially Unnecessary Hospitalizations in Children With Pneumonia. Hosp Pediatr 2022; 12:788-806. [PMID: 36000331 DOI: 10.1542/hpeds.2022-006608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterize the outcomes of children with community acquired pneumonia (CAP) across 41 United States hospitals and evaluate factors associated with potentially unnecessary admissions. METHODS We performed a cross-sectional study of patients with CAP from 41 United States pediatric hospitals and evaluated clinical outcomes using a composite ordinal severity outcome: mild-discharged (discharged from the emergency department), mild-admitted (hospitalized without other interventions), moderate (provision of intravenous fluids, supplemental oxygen, broadening of antibiotics, complicated pneumonia, and presumed sepsis) or severe (ICU, positive-pressure ventilation, vasoactive infusion, chest drainage, extracorporeal membrane oxygenation, severe sepsis, or death). Our primary outcome was potentially unnecessary admissions (ie, mild-admitted). Among mild-discharged and mild-admitted patients, we constructed a generalized linear mixed model for mild-admitted severity and assessed the role of fixed (demographics and clinical testing) and random effects (institution) on this outcome. RESULTS Of 125 180 children, 68.3% were classified as mild-discharged, 6.6% as mild-admitted, 20.6% as moderate and 4.5% as severe. Among admitted patients (n = 39 692), 8321 (21%) were in the mild-admitted group, with substantial variability in this group across hospitals (median 19.1%, interquartile range 12.8%-28.4%). In generalized linear mixed models comparing mild-admitted and mild-discharge severity groups, hospital had the greatest contribution to model variability compared to all other variables. CONCLUSIONS One in 5 hospitalized children with CAP do not receive significant interventions. Among patients with mild disease, institutional variation is the most important contributor to predict potentially unnecessary admissions. Improved prognostic tools are needed to reduce potentially unnecessary hospitalization of children with CAP.
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Affiliation(s)
- Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Douglas Lorenz
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky
| | - Lilliam Ambroggio
- Section of Pediatric Emergency Medicine and
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, Colorado
| | | | - Jillian M Cotter
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Todd A Florin
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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6
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Katz AJ, Lion RP, Martens T, Newcombe J, Razzouk A, Shih W, Amirnovin R, Gordon BM. Pediatric Surgical Pulmonary Valve Replacement Outcomes After Implementation of a Clinical Pathway. World J Pediatr Congenit Heart Surg 2022; 13:420-425. [PMID: 35757942 DOI: 10.1177/21501351221098127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Standardization of perioperative care can reduce resource utilization while improving patient outcomes. We sought to describe our outcomes after the implementation of a perioperative clinical pathway for pediatric patients undergoing elective surgical pulmonary valve replacement and compare these results to previously published national benchmarks. METHODS A retrospective single-center descriptive study was conducted of all pediatric patients who underwent surgical pulmonary valve replacement from 2017 through 2020, after the implementation of a clinical pathway. Outcomes included hospital length of stay and 30-day reintervention, readmission, and mortality. RESULTS Thirty-three patients (55% female, median age 11 [7, 13] years, 32 [23, 44] kg) were included in the study. Most common diagnosis and indication for surgery was Tetralogy of Fallot (61%) with pulmonary valve insufficiency (88%). All patients had prior cardiac surgery. Median hospital length of stay was 2 [2, 2] days, and longest length of stay was three days. There were no 30-day readmissions, reinterventions, or mortalities. Median follow-up time was 19 [9, 31] months. CONCLUSIONS Formalization of a perioperative surgical pulmonary valve replacement clinical pathway can safely promote short hospital length of stay without any short-term readmissions or reinterventions, especially when compared with previously published benchmarks. Such formalization enables the dissemination of best practices to other institutions to reduce hospital length of stay and limit costs.
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Affiliation(s)
- Alex J Katz
- Department of Pediatrics, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Richard P Lion
- Department of Pediatrics, Division of Critical Care, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Timothy Martens
- Department of Cardiovascular and Thoracic Surgery, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Jennifer Newcombe
- Department of Cardiovascular and Thoracic Surgery, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Anees Razzouk
- Department of Cardiovascular and Thoracic Surgery, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Wendy Shih
- School of Public Health, 4608Loma Linda University, Loma Linda, CA, USA
| | - Rambod Amirnovin
- Department of Pediatrics, Division of Critical Care, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Brent M Gordon
- Department of Pediatrics, Division of Cardiology, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
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7
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Liang CS, Forster C, Williams AE. High-Value Care During the COVID-19 Pandemic: Lessons Learned and Future Opportunities. Hosp Pediatr 2022; 12:e216-e218. [PMID: 35641475 DOI: 10.1542/hpeds.2021-006511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Cynthia S Liang
- Department of Pediatrics
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Catherine Forster
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Allison E Williams
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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8
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Jeziorczak PM, Frenette RS, Aprahamian CJ. Liposomal Bupivacaine Injection in Nuss Procedure Allows Narcotic Avoidance and Improved Outcomes. J Laparoendosc Adv Surg Tech A 2021; 31:1384-1388. [PMID: 34748425 DOI: 10.1089/lap.2021.0357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The Nuss procedure has provided a minimally invasive surgical solution for pectus excavatum with excellent long-term outcomes. However, opioid avoidance, cost reduction, and length of stay (LOS) still offer room for improvement. The focus of this study is to identify the impact of Bupivacaine liposome injectable suspension (Exparel) on outcomes. Methods: A retrospective review at a Pediatric specialty hospital from October 1, 2014 to December 31, 2019 was performed. All patients underwent a Nuss procedure (n = 19) for pectus excavatum. The cohort comprised a control group that did not use liposomal Bupivacaine (Standard, n = 9) and an interventional group that received liposomal Bupivacaine (n = 10). Nonparametric Wilcoxon rank-sum tests and chi-squared or Fisher's exact tests were used to assess significance (P < .05). Results: Overall, the entire population was 68.4% male and had an average age of 15 years. There was a significant difference between the Standard and Liposomal Bupivacaine groups for total cost ($60,746 versus $13,289), total Morphine Milligram Equivalents (MME) (282 versus 76.8 MME) and Epidural Catheter usage (100% versus 0%). There was also a significant difference between groups for LOS (5.00 days versus 3.00 days) and Foley catheter usage (100% versus 20%). Conclusions: There is a significant impact of liposomal Bupivacaine usage on epidural catheter avoidance and opioid administration correlating with a significantly decreased total cost and decreased LOS. While more study is necessary, liposomal Bupivacaine for Nuss procedure offers improvement of postoperative patient outcomes and drastic cost savings.
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Affiliation(s)
- Paul M Jeziorczak
- OSF Healthcare-Children's Hospital of Illinois, Peoria, Illinois, USA.,Department of Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA
| | - Riley S Frenette
- OSF Healthcare-Children's Hospital of Illinois, Peoria, Illinois, USA.,Kirksville College of Osteopathic Medicine, AT Still University, Kirksville, Missouri, USA
| | - Charles J Aprahamian
- OSF Healthcare-Children's Hospital of Illinois, Peoria, Illinois, USA.,Department of Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA
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9
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Shaikh N, Umscheid J, Rizvi S, Bhatt P, Vasudeva R, Yagnik P, Bhatt N, Donda K, Dapaah-Siakwan F. National Trends of Acute Osteomyelitis and Peripherally Inserted Central Catheters in Children. Hosp Pediatr 2021; 11:662-670. [PMID: 34187789 DOI: 10.1542/hpeds.2020-005794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Although a growing body of evidence suggests that early transition to oral antimicrobial therapy is equally efficacious to prolonged intravenous antibiotics for treatment of acute pediatric osteomyelitis, little is known about the pediatric trends in peripherally inserted central catheter (PICC) placements. Using a national database, we examined incidence rates of pediatric hospitalizations for acute osteomyelitis in the United States from 2007 through 2016, as well as the trends in PICC placement, length of stay (LOS), and cost associated with these hospitalizations. METHODS This was a retrospective, serial cross-sectional study of the National Inpatient Sample database from 2007 through 2016. Patients ≤18 years of age with acute osteomyelitis were identified by using appropriate diagnostic codes. Outcomes measured included PICC placement rate, LOS, and inflation-adjusted hospitalization costs. Weighted analysis was reported, and a hierarchical regression model was used to analyze predictors. RESULTS The annual incidence of acute osteomyelitis increased from 1.0 to 1.8 per 100 000 children from 2007 to 08 to 2015 to 16 (P < .0001), whereas PICC placement rates decreased from 58.8% to 5.9% (P < .0001). Overall, changes in LOS and inflation-adjusted hospital costs were not statistically significant. PICC placements and sepsis were important predictors of increased LOS and hospital costs. CONCLUSIONS Although PICC placement rates for acute osteomyelitis significantly decreased in the face of increased incidence of acute osteomyelitis in children, LOS and hospital costs for all hospitalizations remained stable. However, patients receiving PICC placements had longer LOS. Further studies are needed to explore the long-term outcomes of reduced PICC use.
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Affiliation(s)
- Nadia Shaikh
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Illinois;
| | - Jacob Umscheid
- School of Medicine, University of Kansas, Wichita, Kansas
| | - Syed Rizvi
- Department of Pediatrics, St. Louis University, St. Louis, Missouri
| | - Parth Bhatt
- United Hospital Center, Bridgeport, West Virginia
| | | | - Priyank Yagnik
- School of Medicine, University of Kansas, Wichita, Kansas
| | - Neel Bhatt
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Keyur Donda
- Department of Pediatrics, University of South Florida, Tampa, Florida; and
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10
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Truelove JJ, House SA. Reducing PICC Placement in Pediatric Osteomyelitis: A Diamond in the Deimplementation Rough? Hosp Pediatr 2021; 11:e111-e114. [PMID: 34187790 DOI: 10.1542/hpeds.2021-006029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jessica J Truelove
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire .,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Samantha A House
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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11
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Affiliation(s)
| | - Paul L Aronson
- Sections of Pediatric Emergency Medicine and.,Emergency Medicine, School of Medicine, Yale University, New Haven, Connecticut
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12
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Cost of clinician-driven tests and treatments in very low birth weight and/or very preterm infants. J Perinatol 2021; 41:295-304. [PMID: 33268831 DOI: 10.1038/s41372-020-00879-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/07/2020] [Accepted: 11/12/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To rank clinician-driven tests and treatments (CTTs) by their total cost during the birth hospitalization for preterm infants. STUDY DESIGN Retrospective cohort of very low birth weight (<1500 g) and/or very preterm (<32 weeks) subjects admitted to US children's hospital Neonatal Intensive Care Units (2012-2018). CTTs were defined as pharmaceutical, laboratory and imaging services and ranked by total cost. RESULTS 24,099 infants from 51 hospitals were included. Parenteral nutrition ($85M, 32% of pharmacy costs), blood gas analysis ($34M, 29% of laboratory costs), and chest radiographs ($18M, 31% of imaging costs) were the costliest CTTs overall. More than half of CTT-related costs occurred during 10% of hospital days. CONCLUSIONS The majority of CTT-related costs were from commonly used tests and treatments. Targeted efforts to improve value in neonatal care may benefit most from focusing on reducing unnecessary utilization of common tests and treatments, rather than infrequently used ones.
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13
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Bettenhausen JL, Hall M, Doupnik SK, Markham JL, Feinstein JA, Berry JG, Gay JC. Hospitalization Outcomes for Rural Children with Mental Health Conditions. J Pediatr 2021; 229:240-246.e1. [PMID: 33010261 PMCID: PMC7855022 DOI: 10.1016/j.jpeds.2020.09.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/03/2020] [Accepted: 09/25/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To identify where rural children with mental health conditions are hospitalized and to determine differences in outcomes based on location of hospitalization. STUDY DESIGN This is a retrospective cohort analysis of US rural children aged 0-18 years with a mental health hospitalization between January 1, 2014, and November 30, 2014, using the 2014 Agency for Healthcare Research and Quality's Nationwide Readmissions Database. Hospitalizations for rural children were categorized by children's hospitals, metropolitan non-children's hospitals, or rural hospitals. Associations between hospital location and outcomes were assessed with logistic (readmission) and negative binomial regression (length of stay [LOS]) models. Classification and regression trees (CART) were used to describe the characteristics of most common hospitalizations at a rural hospital. RESULTS Of 21 666 mental health hospitalizations of rural children, 20.6% were at rural hospitals. After adjustment for clinical and demographic characteristics, LOS was higher at metropolitan non-children's and children's hospitals compared with rural hospitals (LOS: adjusted rate ratio [aRR], 1.35 [95% CI 1.29-1.41] and 1.33 [95% CI, 1.25-1.41]; P < .01 for all). The 30-day readmission was lower at metropolitan non-children's and children's hospitals compared with rural hospitals (aOR, 0.73 [95% CI, 0.63-0.84] and 0.59 [95% CI, 0.48-0.71]; P < .001 for all). Adolescent males living in poverty with externalizing behavior disorder had the highest percentage of hospitalization at rural hospitals (69.4%). CONCLUSIONS Although hospitalizations at children's and metropolitan non-children's hospitals were longer, patient outcomes were more favorable.
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Affiliation(s)
- Jessica L Bettenhausen
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
| | - Matt Hall
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO; Children's Hospital Association, Lenexa, KS
| | - Stephanie K Doupnik
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Jessica L Markham
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - James A Feinstein
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Jay G Berry
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - James C Gay
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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14
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Berry JG, Chiang VW, Landrigan CP. The Elephant in the Hospital Room Charge. Pediatrics 2020; 145:peds.2020-0619. [PMID: 32366613 DOI: 10.1542/peds.2020-0619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jay G Berry
- Department of Pediatrics, Harvard Medical School, Harvard University and Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Vincent W Chiang
- Department of Pediatrics, Harvard Medical School, Harvard University and Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Christopher P Landrigan
- Department of Pediatrics, Harvard Medical School, Harvard University and Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
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