Intercenter Cost Variation for Perinatal Hypoxic-Ischemic Encephalopathy in the Era of Therapeutic Hypothermia - 25/05/16

Doi : 10.1016/j.jpeds.2016.02.033

An N. Massaro, MD ^1,^⁎ , Karna Murthy, MD, MSc ^2,³, Isabella Zaniletti, PhD ⁴, Noah Cook, MD, MTR ⁵, Robert DiGeronimo, MD ⁶, Maria L.V. Dizon, MD, MSc ², Shannon E.G. Hamrick, MD ⁷, Victor J. McKay, MD ⁸, Girija Natarajan, MD ⁹, Rakesh Rao, MD ¹⁰, Troy Richardson, MS, MPH, PhD ⁴, Danielle Smith, MD ¹¹, Amit M. Mathur, MD ¹⁰
on behalf of the
Children's Hospital Neonatal Consortium^{^∗}
List of members of Children's Hospital Neonatal Consortium and site sponsors for the Children's Hospitals Neonatal Database is available at www.jpeds.com (Appendix).
Francine Dykes, MD, Anthony Piazza, MD, Gregory Sysyn, MD, Carl Coghill, MD, Ramasubbareddy Dhanireddy, MD, Anne Hansen, MD, Tanzeema Hossain, MBChB, Karna Murthy, MD, MSc, Kristina Reber, MD, Rashmin Savani, MD, Luc Brion, MD, Theresa Grover, MD, Girija Natarajan, MD, Annie Chi, MD, Yvette Johnson, MD, Gautham Suresh, MD, Eugenia Pallotto, MD, Becky Rodgers, MD, Robert Lyle, MD, Steven Chin, MD, Priscilla Joe, MD, Arthur D'Harlingue, MD, Jacquelyn Evans, MD, Michael Padula, MD, MBI, Beverly Brozanski, MD, Amit Mathur, MD, Rakesh Rao, MD, Victor McKay, MD, Mark Speziale, MD, Billie Short, MD, Kevin Sullivan, MD, Robert Di Geronimo, MD, Michael Uhing, MD, Kathleen Meskin, RN, BSN, Lisa Jentsch, RN, MBA, John Grebe, MD, Rajan Wadhawan, MD, Elizabeth Jacobson, MD, Jeanette Asselin, David Durand, Francine Dykes, Jacquelyn Evans : Chair, Karna Murthy, Michael Padula, Eugenia Pallotto, Kristina Reber, Billie Lou Short

¹ Children's National Health System and the Department of Pediatrics, George Washington University School of Medicine, Washington, DC
² Ann and Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
³ Children's Hospitals Neonatal Consortium, Inc
⁴ Children's Hospitals Association, Overland Park, KS
⁵ Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
⁶ Department of Pediatrics, University of Utah and the Primary Children's Medical Center, Salt Lake City, UT
⁷ Department of Pediatrics and Children's Healthcare of Atlanta at Egleston, Emory University, Atlanta, GA
⁸ All Children's Hospital, St Petersburg, FL
⁹ Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI
¹⁰ Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
¹¹ Children's Hospital of Colorado and Department of Pediatrics, University of Colorado, Aurora, CO

^∗Reprint requests: An N. Massaro, MD, Division of Neonatology, Children's National Health Systems, 111 Michigan Ave, NW, Washington, DC 20010.Division of NeonatologyChildren's National Health Systems111 Michigan Ave, NWWashingtonDC20010

Abstract

Objective

To quantify intercenter cost variation for perinatal hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals.

Study design

Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes.

Results

Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86%) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29% of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs.

Conclusions

There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.

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Keywords : newborn, hypothermia, neonatal intensive care unit, intercenter variation, cost

Abbreviations : CHND, CMI, CTC, ECMO, EEG, HIE, ICU, iNO, LC-FO, MRI, NICU, PHIS

Plan

Costs per Case and Variation in Costs across Hospitals

Costs and Clinical Outcomes

Discussion

The Children's Hospital Neonatal Consortium has partnered with Children's Hospital Association, Inc (Overland Park, KS) to design, launch, and maintain the database, as well as provide administrative and analytic support. I.Z. and T.R. are employees of the Children's Hospital Association. The other authors declare no conflicts of interest.

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Vol 173

P. 76 - juin 2016 Retour au numéro

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Intercenter Cost Variation for Perinatal Hypoxic-Ischemic Encephalopathy in the Era of Therapeutic Hypothermia - 25/05/16

Abstract

Objective

Study design

Results

Conclusions

Plan

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