Center Variation in Hospital Costs for Patients Undergoing Congenital Heart Surgery

Pasquali, Sara K.; Sun, Jie‐Lena; d'Almada, Phil; Jaquiss, Robert D.B.; Lodge, Andrew J.; Miller, Neal; Kemper, Alex R.; Lannon, Carole; Li, Jennifer S.

doi:10.1161/circoutcomes.110.958959

Cited by 96 publications

(87 citation statements)

References 18 publications

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“…Previous studies have suggested that LOS and postoperative complications are important drivers of high cost on a patient level; however, the impact of these variables on resource use on a hospital level has not been previously examined. 3,7 Together these variables accounted for more than a quarter of the total observed variation in our study. The impact of complications was less clear for the lower complexity operations, which may be related in part to the lower prevalence of complications in general in these patients.…”

Section: Discussionmentioning

confidence: 74%

“…We were also able to assess complications specific to congenital heart surgery. [3][4][5][6][7] Standardized information collected across hospitals within the PHIS Database allowed calculation of total hospital costs, which better estimate the resources consumed to carry out the service provided, compared with charge data reported in previous studies, which only reflect what the hospital billed for a service, may vary across hospitals, and overestimate cost. 6,7 These types of data linkages can maximize the strengths and mitigate the weaknesses of each data set, and allow for analyses not possible within each individual data set alone.…”

Section: Discussionmentioning

confidence: 99%

“…We focusedon these factors, as previous studies have suggested that they may have an important impact on resource use in this population overall. 3,7 To conduct these analyses, the estimated standard deviation of the center level intercept of the models with patient characteristics alone was compared with those from models with complication rates and LOS included. The percent reduction in the estimated standard deviation was used to quantify the amount of between-center variation explained by these variables.…”

Section: Data Collectionmentioning

confidence: 99%

“…In our assessment of factors associated with variation in cost across hospitals, we focused primarily on an evaluation of postoperative complication rate and LOS. 3,7 Further studies are needed to provide additional insight into other factors, such as potential differences in use of laboratory testing and imaging. 4 In addition, resource use can be assessed through a variety of different methods, each of which are associated with certain strengths and limitations.…”

Section: Figurementioning

confidence: 99%

“…Previous studies have been limited by the use of administrative data sets and inherent difficulties related to case ascertainment and risk adjustment, such that there are limited data available to hospitals, payers, and policymakers regarding average costs for the most common operations, the range of costs across institutions, and potential mechanisms underlying any variation identified. [3][4][5][6][7][8] This information has become increasingly important in an era of rising health care expenditures, where recent initiatives aim to provide hospitals with incentives to both improve quality of care and reduce costs. 9 A better understanding of factors impacting hospital costs for common and resource-intense conditions such as congenital heart disease is critical to the successful design and implementation of such initiatives.…”

mentioning

confidence: 99%

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Variation in Congenital Heart Surgery Costs Across Hospitals

2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Congenital heart disease is known to be a commonly treated and resource-intense condition across children' s hospitals, yet knowledge regarding the degree of cost variation across hospitals and associated factors is lacking.WHAT THIS STUDY ADDS: Using a linked clinical and administrative data set, we establish benchmarks for hospital costs for common congenital heart operations, and demonstrate wide variation in cost between hospitals related in part to differences in length of stay and complications. abstract BACKGROUND: A better understanding of costs associated with common and resource-intense conditions such as congenital heart disease has become increasingly important as children' s hospitals face growing pressure to both improve quality and reduce costs. We linked clinical information from a large registry with resource utilization data from an administrative data set to describe costs for common congenital cardiac operations and assess variation across hospitals. METHODS:Using linked data from The Society of Thoracic Surgeons and Pediatric Health Information Systems Databases (2006Databases ( -2010, estimated costs/case for 9 operations of varying complexity were calculated. Between-hospital variation in cost and associated factors were assessed by using Bayesian methods, adjusting for important patient characteristics. RESULTS:Of 12 718 operations (27 hospitals) included, median cost/ case increased with operation complexity (atrial septal defect repair, [$25 499] to Norwood operation, [$165 168]). Significant betweenhospital variation (up to ninefold) in adjusted cost was observed across operations. Differences in length of stay (LOS) and complication rates explained an average of 28% of between-hospital cost variation. For the Norwood operation, high versus low cost hospitals had an average LOS of 50.8 vs 31.8 days and a major complication rate of 50% vs 25.3%. High volume hospitals had lower costs for the most complex operations.CONCLUSIONS: This study establishes benchmarks for hospital costs for common congenital heart operations and demonstrates wide variability across hospitals related in part to differences in LOS and complication rates. These data may be useful in designing initiatives aimed at both improving quality of care and reducing cost. Pediatrics 2014;133:e553-e560 AUTHORS:

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

mentioning

confidence: 99%

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Variation in Congenital Heart Surgery Costs Across Hospitals

2014

PEDIATRICS

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Factors associated with inpatient hospitalizations among patients aged 1 to 64 years with Congenital heart defects, Arkansas 2006 to 2011

Simeone

Oster

Hobbs

et al. 2015

Birth Defects Research

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Background Individuals with congenital heart defects (CHDs) have high hospital resource use. We sought to identify factors associated with hospital costs and multiple hospitalizations among individuals with CHDs. Methods Data from the 2006 to 2011 Healthcare Cost and Utilization Project Arkansas State Inpatient Databases were linked across encrypted patient identifiers to develop a cohort of Arkansas residents aged 1 to 64 years who were hospitalized at least once with a CHD during this time period. Infants were excluded because patient identifiers were missing for 18 to 52% each year. CHDs were identified using principal and secondary International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses codes. All hospitalizations of individuals ever admitted with a CHD were included. Mean and median patient-level costs were estimated; the association of hospital costs and patient readmissions were examined with linear and logistic regression. Results There were 1,185,868 inpatient hospitalizations of Arkansas residents aged 1 to 64 years between 2006 and 2011; these were accrued by 603,925 patients. Of those, 2542 patients (0.42%) had at least one hospitalization with a CHD diagnosis. Total costs for these 2542 patients were $126,999,837 and they accumulated 7898 hospitalizations. Factors associated with increased costs included patient age, CHD type, cardiac procedures, and comorbidities. Factors associated with hospital readmission within 1 year included age, CHD type, expected payer, and comorbidities. Conclusion Individuals with CHDs in Arkansas experience variation in hospital use and costs by patient characteristics. Future research should investigate factors associated with readmissions, cardiac procedures, and comorbidities, as these are strongly associated with hospital costs.

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