Factors associated with increased resource utilization for congenital heart disease
Factors associated with increased resource utilization for congenital heart disease
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DOI：
10.1542/peds.2004-2071
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发表时间：
2005-09-01
期刊：
影响因子：
8
通讯作者：
Jenkins, KJ
中科院分区：
文献类型：
--
作者：
Connor, JA;Gauvreau, K;Jenkins, KJ
Objective.确定与先天性心脏病手术高资源利用相关的患者、机构和区域因素。我们使用的出院数据来自医疗保健成本和利用项目（HCUP）儿童住院患者数据库（KID）2000年（数据来自27个州）。采用国际疾病分类第九次修订版临床修改代码对18岁以下的先天性心脏病患者进行识别。高资源利用率的入院被定义为那些在最高的十分位数的总医院费用。单变量和多变量分析，并没有死亡，以确定人口和医院的预测因素的情况下，高资源的使用。使用先天性心脏手术风险组的风险调整来近似病例组合严重程度。地区和国家的差异也进行了检查。在10569例先天性心脏病手术中，住院费用中位数为53828美元。全州范围内的高资源使用录取人数存在差异;加州、科罗拉多、佛罗里达、夏威夷、宾夕法尼亚和得克萨斯州更有可能出现高资源使用情况，而缅因州和南卡罗来纳州的可能性较小。随后进行分析，调整基线状态效应。使用广义估计方程模型的多变量分析揭示了先天性心脏病手术风险类别的风险调整（比值比[ OR]：1.66-14.1），年龄（OR：3.81），早产（OR：4.85），存在其他主要非心脏结构异常（OR：2.53），医疗保险（OR：1.48），并在周末入院（OR：1.62）是高成本病例的独立预测因素。虽然在单变量分析中发现了一些机构差异，但性别、种族、床位大小、教学和儿童医院状况、医院所有权和心脏病病例的医院数量与高资源利用率的可能性无关。各州先天性心脏病手术资源利用率高的频率各不相同。具有更大疾病复杂性、年龄更小、早产、其他异常和医疗补助且在周末入院的患者更有可能导致高资源利用率。不同类型的机构在高费用入学方面没有差异，无论儿童医院或教学状况如何。
Objective. To identify patient, institutional, and regional factors that are associated with high resource utilization for congenital heart surgery.Methods. We used hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database ( KID) year 2000 ( data from 27 states). Patients who had congenital heart surgery and were younger than 18 years were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. High resource utilization admissions were defined as those in the highest decile for total hospital charges. Univariate and multivariate analyses with and without deaths were used to determine demographic and hospital predictors for cases of high resource use. Case-mix severity was approximated using Risk Adjustment for Congenital Heart Surgery risk groups. Regional and state differences were also examined.Results. Among 10 569 cases of congenital heart surgery identified, median total hospital charges were $53 828. Statewide differences in the number of high resource use admissions were present; California, Colorado, Florida, Hawaii, Pennsylvania, and Texas were more likely to have high resource use cases, and Maine and South Carolina were less likely. Subsequent analyses were performed adjusting for baseline state effects. Multivariate analyses using generalized estimating equations models revealed Risk Adjustment for Congenital Heart Surgery risk category ( odds ratio [ OR]: 1.66-14.1), age ( OR: 3.81), prematurity ( OR: 4.85), the presence of other major noncardiac structural anomalies ( OR: 2.53), Medicaid insurance ( OR: 1.48), and admission during a weekend ( OR: 1.62) to be independent predictors of a higher odds of high cost cases. Although some institutional differences were noted in univariate analyses, gender, race, bed size, teaching and children's hospital status, hospital ownership, and hospital volume of cardiac cases were not independently associated with greater odds of high resource utilization.Conclusions. States varied in the frequency of high resource utilization for congenital heart surgery. Patients who had greater disease complexity, younger age, prematurity, other anomalies, and Medicaid and were admitted during a weekend were more likely to result in high resource utilization. Institutions of various types did not differ in high cost admissions, regardless of children's hospital or teaching status.