Intercenter Cost Variation for Perinatal Hypoxic-Ischemic Encephalopathy in the Era of Therapeutic Hypothermia
Intercenter Cost Variation for Perinatal Hypoxic-Ischemic Encephalopathy in the Era of Therapeutic Hypothermia
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DOI：
10.1016/j.jpeds.2016.02.033
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发表时间：
2016-06-01
影响因子：
5.1
通讯作者：
Mathur, Amit M.
中科院分区：
文献类型：
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作者：
Massaro, An N.;Murthy, Karna;Mathur, Amit M.
目的量化各儿童医院治疗性低温治疗围产期缺氧缺血性脑病（HIE）的中心间费用差异。研究设计前瞻性地收集儿童医院新生儿数据库和儿科健康信息系统的数据，在调整HIE严重程度、死亡率、住院时间、体外支持或一氧化氮的使用和呼吸机天数后，评估总住院费用的中心间成本变化。其次，重症监护病房床位、脑电图（EEG）、实验室和神经影像学检查的费用也进行了评估。成本根据有利结果（磁共振成像正常生存）和不良结果（出院时死亡或需要胃管喂养）的频率进行背景化，以确定成本相对较低和结果较好的中心。结果在19个地区新生儿重症监护病房接受治疗性低温治疗的822例HIE患儿中，有704例（86%）存活出院。幸存者/例的中位成本为58 552美元（IQR为32 476- 130 203美元），非幸存者为29 760美元（IQR为16 897- 61 399美元）。调整疾病严重程度和选择干预措施后，中心间差异解释了总住院费用变化的29%。尽管低成本和预后良好的中心在EEG成本方面排名较高，但各中心之间成本差异最大的是EEG使用。结论不同地区儿童医院治疗HIE的中心间费用差异显著。我们的调查有助于建立成本参考，并加强与HIE相关的质量改进和资源利用项目。
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.