Hospital Variation in Neonatal Abstinence Syndrome Incidence, Treatment Modalities, Resource Use, and Costs Across Pediatric Hospitals in the United States, 2013 to 2016.
Hospital Variation in Neonatal Abstinence Syndrome Incidence, Treatment Modalities, Resource Use, and Costs Across Pediatric Hospitals in the United States, 2013 to 2016.
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DOI：
10.1542/hpeds.2017-0077
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发表时间：
2018-01-01
影响因子：
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通讯作者：
Ozonoff, Al
中科院分区：
文献类型：
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作者：
Milliren, Carly E;Gupta, Munish;Ozonoff, Al
背景：随着阿片类药物在美国的流行，全国新生儿禁欲综合征(NAS)的发病率有所上升。药物治疗对医院使用的影响尚未得到很好的证实。我们调查了最近在儿科医院住院的NAS新生儿人数，医院在药物治疗方面的差异，以及治疗对新生儿住院期间资源利用的影响，包括住院时间(LOS)、再次住院和调整后的生活成本。方法：我们纳入了2013年1月至2016年3月在儿科健康信息系统中的医院出院的住院患者。我们比较了患有NAS的新生儿和没有NAS的新生儿在人口统计学、社会经济、临床特征和医院资源使用方面的差异。我们还通过药物治疗比较了非酒精性鼻炎新生儿的这些特征。结果：这项分析包括来自23家医院的136762例新生儿。在这些人中，2%的人被诊断为NAS。与其他新生儿相比，NAS新生儿的LOS较长(18.7天比2.9天；P=0.004)。患有NAS的新生儿平均每次住院费用是后者的10倍(37584美元对3,536美元；P=.003)。在患有NAS的新生儿中，70%接受了药物治疗，但住院药物治疗率差异很大(范围：13%-90%)。接受药物治疗的NAS新生儿的LOS(22.0天比10.9天；P=0.004)长于其他NAS新生儿。接受药物治疗的NAS新生儿的总费用是未接受药物治疗的NAS新生儿的两倍多(44720美元对20708美元；P=0.002)。结论：NAS新生儿，特别是那些接受药物治疗的新生儿，住院时间更长，费用更高。药物治疗的显著差异反映了实践标准化的机会和资源使用的大幅减少。
BACKGROUND: The national incidence of neonatal abstinence syndrome (NAS) has increased with the opioid epidemic in the United States. The impact of pharmacologic treatment on hospital use is not well established. We examined the recent population of neonates with NAS admitted to pediatric hospitals, hospital variation in pharmacologic treatment, and the effect of treatment on resource use during neonatal hospitalization, including length of stay (LOS), readmission, and cost-of-living adjusted hospital costs.METHODS: We included inpatients discharged between January 2013 and March 2016 from hospitals in the Pediatric Health Information System. We compared neonates with NAS to those without on demographic, socioeconomic, clinical characteristics and hospital resource use. We also compared neonates with NAS on these characteristics by pharmacologic treatment.RESULTS: This analysis included 136762 neonatal encounters from 23 hospitals. Of these, 2% had a diagnosis of NAS. Compared with other neonates, neonates with NAS had a longer LOS (18.7 vs 2.9 days; P = .004). Average costs per admission were 10 times higher for neonates with NAS ($37584 vs $3536; P = .003). Of neonates with NAS, 70% were treated pharmacologically with wide variation in hospital rates of pharmacotherapy (range: 13%-90%). Pharmacologically-treated neonates with NAS experienced a longer LOS (22.0 vs 10.9 days; P = .004) than other neonates with NAS. Total costs for pharmacologically-treated neonates with NAS were over 2 times higher ($44720 vs $20708; P = .002) than neonates with NAS treated without pharmacotherapy.CONCLUSIONS: Neonates with NAS, particularly those treated pharmacologically, have lengthier, more expensive hospital stays. Significant variation in pharmacologic treatment reflects opportunities for practice standardization and substantial reductions in resource use.