Hospital Utilization and Costs Among Preterm Infants by Payer: Nationwide Inpatient Sample, 2009
Hospital Utilization and Costs Among Preterm Infants by Payer: Nationwide Inpatient Sample, 2009
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DOI：
10.1007/s10995-015-1911-y
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发表时间：
2016-04-01
影响因子：
2.3
通讯作者：
Goodness, Brian M.
中科院分区：
文献类型：
--
作者：
Barradas, Danielle T.;Wasserman, Martin P.;Goodness, Brian M.
目标 描述在《平价医疗法案》实施之前付款人与早产或低出生体重儿（早产/低出生体重）相关的医院利用率和费用，并确定早产/低出生体重婴儿接受的护理质量需要改进的领域。方法 使用 2009 年全国住院患者样本描述早产儿/低出生体重儿的医院利用率（定义为平均住院时间（LOS，天数）、出生住院的二次诊断、再住院的初次诊断以及转院状态）和费用。结果 大约 9.1% 的住院治疗 (n = 4,167,900) 是早产儿/低出生体重儿；然而，这些分娩住院费用占总费用的 43.4%。所有婴儿的再住院率总体为 5.9%，但占总费用的 22.6%。所有付款人类型都观察到了这种模式。医疗补助覆盖的早产儿/低出生体重儿的再住院率 (7.6%) 是商业保险婴儿 (4.3%) 的两倍。新生儿转移在早产儿/低出生体重儿中更为常见，其分娩和住院由医疗补助 (7.3%) 承保，而商业保险 (6.5%) 承保。无保险/自费的早产儿和低出生体重儿在出生后第一年在医院内死亡的比率为每 1000 人出院 91 人，几乎是医疗补助（每 1000 人 37 人）或商业保险（每 1000 人 32 人）承保的早产儿和低出生体重儿的三倍。结论 比较医疗补助和商业保险承保的早产儿/低出生体重儿，住院时间和费用差异不大。然而，医疗补助和 CHIP 在减少再住院和新生儿转移方面存在改进的机会。
Objectives To describe hospital utilization and costs associated with preterm or low birth weight births (preterm/LBW) by payer prior to implementation of the Affordable Care Act and to identify areas for improvement in the quality of care received among preterm/LBW infants. Methods Hospital utilization-defined as mean length of stay (LOS, days), secondary diagnoses for birth hospitalizations, primary diagnoses for rehospitalizations, and transfer status-and costs were described among preterm/LBW infants using the 2009 Nationwide Inpatient Sample. Results Approximately 9.1 % of included hospitalizations (n = 4,167,900) were births among preterm/LBW infants; however, these birth hospitalizations accounted for 43.4 % of total costs. Rehospitalizations of all infants occurred at a rate of 5.9 % overall, but accounted for 22.6 % of total costs. This pattern was observed across all payer types. The prevalence of rehospitalizations was nearly twice as high among preterm/LBW infants covered by Medicaid (7.6 %) compared to commercially-insured infants (4.3 %). Neonatal transfers were more common among preterm/LBW infants whose deliveries and hospitalizations were covered by Medicaid (7.3 %) versus commercial insurance (6.5 %). Uninsured/self-pay preterm and LBW infants died in-hospital during the first year of life at a rate of 91 per 1000 discharges-nearly three times higher than preterm and LBW infants covered by either Medicaid (37 per 1000) or commercial insurance (32 per 1000). Conclusions When comparing preterm/LBW infants whose births were covered by Medicaid and commercial insurance, there were few differences in length of hospital stays and costs. However, opportunities for improvement within Medicaid and CHIP exist with regard to reducing rehospitalizations and neonatal transfers.