Generalized Modeling Approaches to Risk Adjustment of Skewed Outcomes Data

Manning, Willard G.; Basu, Anirban; Mullahy, John

doi:10.3386/t0293

Cited by 242 publications

(365 citation statements)

References 24 publications

(28 reference statements)

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“…A g distribution was used to model cost, whereas LOS was modeled using a negative binomial distribution. 22,28 The VRE indicator was used as a fixed effect along with other covariates such as age, gender, race/ethnicity, insurance, year, and propensity score (to account for variability across the matched cohorts). The matching of case and controls was taken into account by introducing a random effect for the matching identifier.…”

Section: Discussionmentioning

confidence: 99%

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Adams

Eberly

Goudie

et al. 2016

Hospital Pediatrics

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A B S T R A C T OBJECTIVE:Vancomycin-resistant Enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in adults. Few data are available on the epidemiology and impact of VRE infections in children. We hypothesized a significant increase in VRE infections among hospitalized children. Additionally, we predicted that VRE infection would be associated with certain comorbid conditions and increased duration and cost of hospitalization. METHODS:A retrospective study of inpatient pediatric patients was performed using data on hospitalizations for VRE from the Healthcare Cost and Utilization Project Kids' Inpatient Database from 1997 to 2012. We used a multivariable logistic regression model to establish factors associated with VRE infection and a high-dimensional propensity score match to evaluate death, length of stay, and cost of hospitalization. RESULTS: Hospitalizations for VRE infection showed an increasing trend, from 53 hospitalizationsper million in 1997 to 120 in 2012 (P , .001). Conditions associated with VRE included Clostridium difficile infection and other diagnoses involving immunosuppression and significant antibiotic and health care exposure. Patients with VRE infection had a significantly longer length of stay (attributable difference [AD] 2.1 days, P , .001) and higher hospitalization costs (AD $8233, P 5 .004). VRE infection was not associated with an increased risk of death (odds ratio 1.03; 95% confidence interval 0.73-1.47).CONCLUSIONS: VRE infections among hospitalized children are increasing at a substantial rate. This study demonstrates the significant impact of VRE on the health of pediatric patients and highlights the importance of strict adherence to existing infection control policies and VRE surveillance in certain high-risk pediatric populations.

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Section: Discussionmentioning

confidence: 99%

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Adams

Eberly

Goudie

et al. 2016

Hospital Pediatrics

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“…Due to the skewed nature of LOS and cost data, LOS was analyzed using multivariate negative binomial regression and cost was analyzed using multivariate gamma regression. 21 Binary outcomes (ICU admission and 30-day readmission) were analyzed using multivariate logistic regression. The analysis accounted for potential confounding factors by inclusion of the following covariates: age group, gender, race, admission source, and DeyoCharlson Comorbidity Index score.…”

Section: Outcome Measures and Statistical Analysesmentioning

confidence: 99%

Evaluation of incremental healthcare resource burden and readmission rates associated with hospitalized hyponatremic patients in the US

Amin

Deitelzweig

Christian

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:Hyponatremia is a prevalent electrolyte disorder in hospitalized patients indicative of greater morbidity and mortality. A large‐scale retrospective analysis was conducted to evaluate the incremental burden of hospitalized hyponatremic (HN) versus non‐HN patients in terms of hospital resource utilization, costs, and hospital readmissions in the real‐world setting.METHODS:HN patients (≥18 years) were selected from the Premier Hospital Database between January 1, 2007 and March 31, 2010 and matched to a non‐HN control cohort using propensity score matching. Bivariate and multivariate statistics were employed to evaluate the differences in healthcare resource utilization, costs, and hospital readmissions between patient cohorts.RESULTS:Among the matched patient cohorts, length of stay (LOS) (8.8 ± 10.3 vs 7.7 ± 8.5 days, P < 0.001), hospital admission costs ($15,281 ± $24,054 vs $13,439 ± $22,198, P < 0.001), intensive care unit (ICU) LOS (5.5 ± 7.9 vs 4.9 ± 7.1 days, P < 0.001), and ICU costs ($8525 ± $13,342 vs $7597 ± $12,695, P < 0.001) were greater for the HN versus non‐HN cohort, as were hospital readmission rates 30 days postdischarge. Multivariate regressions further demonstrated that hyponatremia was associated with an increase of 10.9% for LOS, 8.2% for total hospitalization costs, 10.2% for ICU LOS, and 8.9% for ICU costs. Additionally, after multivariate adjustment, hyponatremia was associated with a 15.0% increased chance for hospital readmission 30 days postdischarge (P < 0.0001).CONCLUSIONS:Hyponatremia is an independent predictor of increased hospitalization LOS and cost, ICU admission and cost, and 30‐day hospital readmission, and therefore represents a potential target for intervention to reduce healthcare expenditures for a large population of hospitalized hyponatremic patients. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

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“…An assessment of nationally representative hospital discharge data estimated that 7% of inpatient admissions for AHT among patients 0 to 4 years old ended in death during 2000-2009. 20 The data used for this study did not permit investigation of AHT victims' relationships to perpetrators, which might have been associated with patients' insurance coverage after AHT diagnosis. This study examined only the direct medical cost of AHT and did not examine other, probably substantial long-term costs attributable to AHT, such as developmental services, special education, and lifelong medical care and support, such as assistive eating devices, that some AHT victims need.…”

Section: Discussionmentioning

confidence: 99%

“…Research has indicated that gender, age, race or ethnicity, having a young mother, and low socioeconomic status are among the risk factors for AHT. 20 We did not match patients based on non-AHT health conditions, including comorbidities; for any factor not included in the matching algorithm we implicitly assumed an even distribution of that factor among AHT and non-AHT patients, which is a limitation. Our objective was to determine how much medical care for a child with AHT costs above and beyond medical care for a typical child.…”

Section: Discussionmentioning

confidence: 99%

The Medical Cost of Abusive Head Trauma in the United States

2014

PEDIATRICS

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OBJECTIVES-Health consequences of shaken baby syndrome, or pediatric abusive head trauma (AHT), can be severe and long-lasting. We aimed to estimate the multiyear medical cost attributable to AHT. METHODS-UsingTruven Health MarketScan data, 2003-2011, we identified children 0 to 4 years old with commercial or Medicaid insurance and AHT diagnoses. We used exact casecontrol matching based on demographic and insurance characteristics such as age and health plan type to compare medical care between patients with and without AHT diagnoses. Using regression models, we assessed service use (ie, average annual number of inpatient visits per patient) and inpatient, outpatient (including emergency department), drug, and total medical costs attributable to an AHT diagnosis during the 4-year period after AHT diagnosis. RESULTS-We assessed 1209 patients with AHT and 5895 matched controls. Approximately 48% of patients with AHT received inpatient care within 2 days of initial diagnosis, and 25% were treated in emergency departments. AHT diagnosis was associated with significantly greater medical service use and higher inpatient, outpatient, drug, and total costs for multiple years after Reprints Information about ordering reprints can be found online: http://pediatrics.aappublications.org/site/misc/reprints.xhtml Address correspondence to Cora Peterson, PhD, Mailstop F-62, 4770 Buford Highway, CDC National Center for Injury Prevention and Control, Atlanta, GA 30341. cora.peterson@cdc.hhs.gov. Dr Peterson led study design and interpretation of results, conducted data analysis, and drafted and edited the manuscript; Dr Xu assisted with study design and interpretation of results, led and conducted data analysis, and edited the manuscript; Dr Florence initiated the study, assisted with the study design and interpretation of results, conducted data analysis, and edited the manuscript; Dr Parks assisted with study design and interpretation of results and edited the manuscript; Dr Miller, Ms Barr, Mr Barr, and Mr Steinbeigle secured external funding, assisted with study design and interpretation of results, and edited the manuscript; and all authors approved the final manuscript as submitted.The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention and do not necessarily reflect the opinions of the Annie E. Casey Foundation. FINANCIAL DISCLOSURE:The authors have indicated they have no financial relationships relevant to this article to disclose. POTENTIAL CONFLICT OF INTEREST:The authors have indicated they have no potential conflicts of interest to disclose. CONCLUSIONS-Children continue to have substantial excess medical costs for years after AHT. These estimates exclude related nonmedical costs such as special education and disability that also are attributable to AHT. HHS Public AccessKeywords child abuse; shaken baby syndrome; economic analysisThe health consequences of shaken-baby syndrome, or pediatric a...

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Generalized Modeling Approaches to Risk Adjustment of Skewed Outcomes Data

Cited by 242 publications

References 24 publications

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Evaluation of incremental healthcare resource burden and readmission rates associated with hospitalized hyponatremic patients in the US

The Medical Cost of Abusive Head Trauma in the United States

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