Cost Variation Across Centers for the Norwood Operation
Cost Variation Across Centers for the Norwood Operation
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DOI：
10.1016/j.athoracsur.2017.09.001
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发表时间：
2018-03-01
影响因子：
4.6
通讯作者：
Scheurer, Mark A.
中科院分区：
文献类型：
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作者：
McHugh, Kimberly E.;Pasquali, Sara K.;Scheurer, Mark A.
背景诺伍德手术与高卫生保健利用率相关，先前的研究报告了各中心诺伍德费用的显著差异。然而，导致这种成本变化的具体因素尚不清楚。我们在一个多中心队列中评估了诺伍德成本和潜在机制的中心差异。来自儿科心脏网络单心室重建试验的临床数据与来自儿童医院协会住院患者基本数据库的费用数据相关联。通过对根据基线患者特征调整的诺伍德成本进行建模，评估中心差异，并检查与并发症、住院时间（LOS）和特定成本类别的关系。在诺伍德住院期间接受移植或2期姑息治疗的患者被排除。纳入了9个中心（332例患者）。各中心调整后的平均成本/病例差异为4.6倍（范围：50，559美元至230，851美元，p < 0.001）。此外，各研究中心的校正平均并发症数/例（2.6倍变化）和校正平均LOS/例（1.9倍变化）存在差异。并发症的差异解释了各中心63%的成本差异。在考虑并发症后，LOS的差异解释了剩余成本变化的66%。在高成本中心发现7种特殊并发症更常见：胸腔积液、癫痫发作、伤口感染、血栓、肝功能障碍、败血症、坏死性小肠结肠炎（所有p < 0.001）。关于成本类型，食宿/用品和实验室成本是各中心成本差异的主要驱动因素。本研究确定了与诺伍德成本中心差异相关的几个因素，这些因素可能会在随后的旨在提高护理质量和降低成本的举措中成为目标。(C)2018胸外科医师协会
Background. The Norwood operation is associated with high health care utilization, and prior studies reported substantial variability in Norwood costs across centers. However, specific factors driving this cost variation are unclear. We assessed center variability in Norwood costs and underlying mechanisms in a multicenter cohort.Methods. Clinical data from the Pediatric Heart Network Single Ventricle Reconstruction trial were linked with cost data from the Children's Hospital Association Inpatient Essentials database. Center variation was assessed by modeling Norwood costs adjusted for baseline patient characteristics, and the relationship with complications, length of stay (LOS), and specific cost categories was examined. Patients undergoing transplantation or stage 2 palliation during the Norwood admission were excluded.Results. Nine centers (332 patients) were included. Adjusted mean cost/case varied 4.6- fold across centers (range: $50,559 to $230,851, p < 0.001). In addition, variation was found across centers in the adjusted mean number of complications/case (2.6-fold variation) and adjusted mean LOS/case (1.9-fold variation). Differences in complications explained 63% of the cost variation across centers. After accounting for complications, differences in LOS explained 66% of the remaining cost variation. Seven specific complications were found to occur more frequently at high-cost centers: pleural effusion, seizures, wound infection, thrombus, liver dysfunction, sepsis, necrotizing enterocolitis (all p < 0.001). With regard to types of cost, room and board/supplies and laboratory costs were the primary drivers of cost variation across centers.Conclusions. This study identified several factors associated with center variation in Norwood costs, which may be targeted in subsequent initiatives aimed at both improving quality of care and reducing costs. (C) 2018 by The Society of Thoracic Surgeons