Time Trends and Payer Differences in Lengths of Initial Hospitalization for Preterm Infants, Arkansas, 2004 to 2010

Abstract

Objective To examine the time trend in length of stay (LOS) and explore potential differences in neonatal LOS by insurance type for preterm infants in Arkansas between 2004 and 2010. Study Design There were 18,712 preterm infants included in our analyses. Accelerated failure time (AFT) models were used to model neonatal LOS as a function of insurance type and discharge year while adjusting for key maternal and infant characteristics, and complication/anomaly indicators. Results Prior to adjusting for the complication/anomaly indicators, the LOS for preterm infants delivered to mothers in the Medicaid group was 3.2% shorter than those in the private payer group. Furthermore, each subsequent year was associated with a 1.6% increase in the expected LOS. However, after accounting for complications and anomalies, insurance coverage differences in neonatal LOS were not statistically significant while the trend in LOS persisted at a 0.59% increase for each succeeding year. Conclusion All of the apparent differences in LOS by insurance type and more than half of the apparent increase in LOS over time are accounted for by higher rates of complications among privately insured preterm infants and increasing rates of complications for all surviving preterm infants between 2004 and 2010.

Neonates with an Extremely Prolonged Length of Stay: An Analysis of Kids Inpatient Database

“…1 The length-of-stay for preterm birth is also increasing at a pace of 0.59% each year, probably related to the survival of extremely immature infants. 2 The use of advanced technologies in the hospital has also influenced the increased use of technology post-discharge, especially with the capability to provide respiratory and renal support at home for small children. It is reported that infants with prolonged initial hospitalization may also be at risk for increased morbidity and mortality postdischarge.…”