Common Diagnoses and Costs in Pediatric Hospitalization in the US.
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ABSTRACT:
SUBMITTER: Kaiser SV
PROVIDER: S-EPMC8715384 | biostudies-literature | 2022 Mar
REPOSITORIES: biostudies-literature
Publications
Common Diagnoses and Costs in Pediatric Hospitalization in the US.
Kaiser Sunitha V SV Rodean Jonathan J Coon Eric R ER Mahant Sanjay S Gill Peter J PJ Leyenaar JoAnna K JK
JAMA pediatrics 20220301 3
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Project description:ObjectivesSevere sepsis is a significant cause of healthcare use and morbidity among pediatric patients, but little is known about readmission diagnoses. We sought to determine the most common readmission diagnoses after pediatric severe sepsis, the extent to which post-sepsis readmissions may be potentially preventable, and whether patterns of readmission diagnoses differ compared with readmissions after other common acute medical hospitalizations.DesignObservational cohort study.SettingNational Readmission Database (2013-2014), including all-payer hospitalizations from 22 states.PatientsFour-thousand five-hundred twenty-eight pediatric severe sepsis hospitalizations, matched by age, gender, comorbidities, and length of stay to 4,528 pediatric hospitalizations for other common acute medical conditions.InterventionsNone.Measurements and main resultsWe compared rates of 30-day all cause, diagnosis-specific, and potentially preventable hospital readmissions using McNemar's chi-square tests for paired data. Among 5,841 eligible pediatric severe sepsis hospitalizations with live discharge, 4,528 (77.5%) were matched 1:1 to 4,528 pediatric hospitalizations for other acute medical conditions. Of 4,528 matched sepsis hospitalizations, 851 (18.8% [95% CI, 16.0-18.2]) were rehospitalized within 30 days, compared with 775 (17.1% [95% CI, 17.1-20.0]) of matched hospitalizations for other causes (p = 0.02). The most common readmission diagnoses were chemotherapy, device complications, and sepsis, all of which were several-fold higher after sepsis versus after matched nonsepsis hospitalization. Only 11.5% of readmissions were for ambulatory care sensitive conditions compared with 23% of rehospitalizations after common acute medical conditions.ConclusionsMore than one in six children surviving severe sepsis were rehospitalized within 30 days, most commonly for maintenance chemotherapy, medical device complications, or recurrent sepsis. Only a small proportion of readmissions were for ambulatory care sensitive conditions.
| S-EPMC6535212 | biostudies-literature
Project description:Dengue, a mosquito-borne viral infection that affects millions around the world, poses a substantial economic burden in endemic countries. We conducted a prospective costing study in hospitalized pediatric dengue patients at the Lady Ridgeway Hospital for Children (LRHC), a public pediatric hospital in Colombo district, Sri Lanka, to assess household out-of-pocket and hospitalization costs of dengue in pediatric patients during peak dengue transmission season. Between August and October 2013, we recruited 216 hospitalized patients (aged 0-3 years, 27%; 4-7 years, 29%; 8-12 years, 42%) who were clinically or laboratory diagnosed with dengue. Using 2013 US dollars, household out-of-pocket spending, on average, was US$59 (SD 49) per episode and increased with disease severity (DF, US$52; DHF/DSS, US$78). Pediatric dengue patients received free-of-charge medical care during hospitalization at LRHC, and this places a high financial burden on hospitals. The direct medical cost of hospitalization was US$68 (SD 31.4) for DF episode, and US$122.7 (SD 65.2) for DHF/DSS episode. Yet a hospitalized dengue illness episode still accounted for 20% to 35% of household monthly income due to direct and indirect costs. Additionally, a majority of caregivers (70%) sought outpatient care before hospitalization, most of whom (81%) visited private health facilities. Our findings indicate that hospitalized pediatric dengue illness poses a nontrivial cost burden to households and healthcare systems, emphasizing the importance of preventing and controlling the transmission of dengue in endemic countries.
| S-EPMC8274749 | biostudies-literature
Project description:BackgroundChildren's emergency care visits are common, although the costs and reasons for visits vary. This register-based study examines the costs of pediatric emergency care and the diagnoses related to visits made to the Pediatric Emergency Unit at Tampere University Hospital (Tays), Tampere, Finland.MethodsThis retrospective study described pediatric emergency care visits made between September 2018 and December 2019 to a single center in Tampere, Finland. The data were gathered from medical files and from cost-per-patient software and analyzed in groups by age, season, level of treatment in the ED (primary or secondary), and hospitalization, as well as by diagnosis groups.ResultsDuring the study period, 11,454 visits were made. The total costs were over €3,380,000 ($2,837,758), with a median cost per visit was €260 ($217.90). Higher costs were associated with hospitalization and treatment in secondary care. The most common diagnoses were respiratory tract infections, counseling, other infections, GI symptoms, and other reasons.ConclusionSeriously ill children incur the highest costs per visit in pediatric emergency care. Respiratory tract infections are common reasons for emergency care visits, and the reasons why children come to emergency care in Finland are similar to those in other countries.
| S-EPMC10900614 | biostudies-literature
Project description:This retrospective study examined the longitudinal hospital outcomes (costs adjusted for inflation, hospital days, and admissions) associated with the treatment of pediatric, adolescent, and young adult acute lymphoblastic leukemia (ALL). Patients between one and 26 years of age with newly diagnosed ALL, who were treated at Primary Children's Hospital (PCH) in Salt Lake City, Utah were included. Treatment and hospitalization data were retrieved from system-wide cancer registry and enterprise data warehouse. PCH is a member of the Children's Oncology Group (COG) and patients were treated on, or according to, active COG protocols. Treatment-related hospital costs of ALL were examined by computing the average annual growth rates (AAGR). Longitudinal regressions identified patient characteristics associated with costs. A total of 505 patients (46.9% female) were included. The majority of patients had B-cell lineage ALL, 6.7% had T-ALL, and the median age at diagnosis was 4 years. Per-patient, first-year ALL hospitalization costs at PCH rose from $24,197 in 1998 to $37,924 in 2012. The AAGRs were 6.1, 13.0, and 7.6% for total, pharmacy, and room and care costs, respectively. Average days (AAGR = 5.2%) and admissions (AAGR = 3.8%) also demonstrated an increasing trend. High-risk patients had 47% higher costs per 6-month period in the first 5 years from diagnosis than standard-risk patients (P < 0.001). Similarly, relapsed ALL and stem cell transplantations were associated with significantly higher costs than nonrelapsed and no transplantations, respectively (P < 0.001). Increasing treatment-related costs of ALL demonstrate an area for further investigation. Value-based interventions such as identifying low-risk fever and neutropenia patients and managing them in outpatient settings should be evaluated for reducing the hospital burden of ALL.
| S-EPMC4735779 | biostudies-literature
Project description:BackgroundEosinophilia is associated with various conditions, including allergic, infectious, and neoplastic disorders. The diagnostic differential is broad, and data on hypereosinophilia in pediatric patients are limited.ObjectiveThe objectives of this study were to identify cases of hypereosinophilia in a tertiary pediatric medical center, determine clinical characteristics and disease associations, and estimate the incidence of hypereosinophilia in the hospital and geographic populations.MethodsA retrospective chart review included patients younger than 18 years presenting to a tertiary pediatric medical center (January 1, 2008, to May 31, 2017) with absolute eosinophil counts (AECs) greater than or equal to 1.50 thousand eosinophils/microliter (K/μL) recorded on at least 2 occasions at least 4 weeks apart (N = 176). Clinical characteristics, laboratory values, treatment course, and associated diagnoses were evaluated.ResultsThe most common cause of hypereosinophilia in this cohort was secondary hypereosinophilia. Atopic dermatitis, graft-versus-host disease, sickle cell disease, and parasitic infections were the most common conditions associated with hypereosinophilia. Median age at diagnosis was 4.6 (interquartile range, 1.5-10.5) years. Median peak AEC was 3.16 (2.46-4.78) K/μL. Hypereosinophilia occurred most frequently in patients aged between 6 and 11 years (24.4%) and younger than 1 year (18.2%). Patients with neoplasms and immune deficiencies had significantly higher peak AECs than did patients with overlap hypereosinophilic syndrome and atopic diseases (P < .0001).ConclusionsPediatric hypereosinophilia has an incidence of 54.4 per 100,000 persons per year, with children younger than 1 year and aged 6 to 11 years accounting for most affected patients. Pediatric hypereosinophilia is not uncommon and remains underrecognized, highlighting a need for clinicians to identify patients who meet criteria for hypereosinophilia and to pursue a thorough evaluation.
| S-EPMC6842676 | biostudies-literature
Project description:OBJECTIVE:To investigate the longitudinal changes in principal readmission diagnoses within 30 days after hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). STUDY SETTING:Medicare claims data, 2010-2012. STUDY DESIGN:Retrospective cohort study. DATA COLLECTION METHODS:We identified AECOPD hospitalizations aged 65 years and above, and examined the principal 30-day readmission diagnoses (respiratory related, cardiac related, and other conditions). We also constructed Joinpoint regression models to test whether patients with each of the 3 major readmission conditions had a unique temporal pattern of readmission during the 30-day period. PRINCIPAL FINDINGS:Among 76,697 index hospitalizations with AECOPD, 14,090 (18.4%) were readmitted within 30 days. Respiratory-related conditions accounted for 55% of readmissions. The proportion of respiratory-related conditions as the readmission diagnosis decreased from postdischarge day 1 to day 8 (4.0% decrease), and then increased thereafter (13.2% increase; P=0.06). Cardiac-related conditions had a similar nonlinear trend with an inflection point at day 6 (P=0.02), with a subsequent downward trend from day 22 (P=0.01). By contrast, the other conditions increased from day 1 to day 6 (15.0% increase), and then significantly decreased (28.8% decrease; P=0.04). CONCLUSIONS:The proportions of principal discharge diagnosis of readmission changed significantly at around postdischarge day 7. Our findings advance research into identification of the underlying mechanisms and development of targeted interventions to prevent readmissions.
| S-EPMC6041171 | biostudies-literature
Project description:Vaccine effectiveness of BNT162b2 and CoronaVac against COVID-19-associated hospitalization and moderate-to-severe disease due to SARS-CoV-2 Omicron BA.2 is studied from the 1.36 million doses administered to 766,601 of 953,400 children aged 3-11 years and adolescents aged 12-18 years in Hong Kong as of April 2022. These vaccines confer substantial protection.
| S-EPMC9868379 | biostudies-literature
Project description:ImportanceHealth care in the US is often expensive for families; however, there is little transparency in the cost of medical services. The extent to which parents want cost transparency in their children's care is not well characterized.ObjectiveTo explore the preferences and experiences of parents of hospitalized children regarding the discussion and consideration of health care costs in the inpatient care of their children.Design, setting, and participantsThis cross-sectional multicenter survey study included 6 geographically diverse university-affiliated US children's hospitals from November 3, 2017, to November 8, 2018. Participants included a convenience sample of English- and Spanish-speaking parents of hospitalized children nearing hospital discharge. Data were analyzed from January 1, 2020, to June 25, 2021.Main outcomes and measuresParents' preferences and experiences regarding transparency of their child's health care costs. Multivariable linear regression examined associations between clinical and sociodemographic variables with parents' preferences for knowing, discussing, and considering costs in the clinical setting. Factors included family financial difficulties, child's level of chronic disease, insurance payer, deductible, family poverty level, race, ethnicity, parental educational level, and study site.ResultsOf 644 invited participants, 526 (82%) were enrolled (290 [55%] male), of whom 362 (69%) were White individuals, 400 (76%) were non-Hispanic/Latino individuals, and 274 (52%) had children with private insurance. Overall, 397 families (75%) wanted to discuss their child's medical costs, but only 36 (7%) reported having a cost conversation. If cost discussions were to occur, 294 families (56%) would prefer to speak to a financial counselor. Ninety-eight families (19%) worried discussing costs would hurt the quality of their child's care. Families with a medical financial burden unrelated to their hospitalized child had higher mean agreement that their child's physician should consider the family's costs in medical decision-making than families without a medical financial burden (effect size, 0.55 [95% CI, 0.18-0.92]). No variables were consistently associated with cost transparency preferences.Conclusions and relevanceMost parents want to discuss their child's costs during an acute hospitalization. Discussions of health care costs may be an important, relatively unexplored component of family-centered care. However, these discussions rarely occur, indicating a tremendous opportunity to engage and support families in this issue.
| S-EPMC8456391 | biostudies-literature
Project description:ObjectiveEmergency department (ED) use has increased disproportionately for pediatric psychiatric care. This study aimed to identify predictors of ED use within 30 days of discharge from a pediatric psychiatric hospitalization.MethodsED use was assessed in the 30 days after discharge. Univariate logistic regression modeling identified predictors of ED use, which were used in subsequent multivariate modeling.ResultsGreater number of trauma types (odds ratio [OR]=1.92, 95% confidence interval [CI]=1.50-2.45, z=2.67, p=0.008), generalized anxiety disorder (OR=3.20, 95% CI=1.78-5.76, z=1.98, p=.048), and longer length of stay (OR=1.05, 95% CI=1.03-1.07, z=2.74, p=0.006) were associated with increased ED use within 30 days of discharge.ConclusionsED use may be an important marker of negative outcomes within 30 days of discharge from pediatric psychiatric hospitalization. Patients with high trauma exposure, anxiety, and acuity marked by increased length of stay may require additional services to prevent unplanned ED use for psychiatric crises.
| S-EPMC6602797 | biostudies-literature
Project description:To determine population-based estimates of medical costs attributable to venous thromboembolism (VTE) among patients currently or recently hospitalized for acute medical illness.Population-based cohort study conducted in Olmsted County, Minnesota.Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County residents with objectively diagnosed incident VTE during or within 92 days of hospitalization for acute medical illness over the 18-year period of 1988 to 2005 (n=286). One Olmsted County resident hospitalized for medical illness without VTE was matched to each case for event date (±1 year), duration of prior medical history, and active cancer status. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before their respective event or index date to the earliest of death, emigration from Olmsted County, or December 31, 2011 (study end date). We censored follow-up such that each case and matched control had similar periods of observation. We used generalized linear modeling (controlling for age, sex, preexisting conditions, and costs 1 year before index) to predict costs for cases and controls.Adjusted mean predicted costs were 2.5-fold higher for cases ($62,838) than for controls ($24,464) (P<.001) from index to up to 5 years post index. Cost differences between cases and controls were greatest within the first 3 months after the event date (mean difference=$16,897) but costs remained significantly higher for cases compared with controls for up to 3 years.VTE during or after recent hospitalization for medical illness contributes a substantial economic burden.
| S-EPMC4586032 | biostudies-literature