Asthma: Pediatric Hospitals' Costs, Treatment Practices Vary Widely

HealthLeaders Media News, July 19, 2016

Researchers studying data from 37 major nonprofit U.S. children's hospitals found that ICU usage was 254% higher when comparing the lower eighth to the upper eighth of hospitals.

Hospital costs for pediatric patients with asthma can vary by as much as 87%.

Researchers who analyzed hospital records in a large national database found that even when patients were grouped by characteristics like age or severity of illness, hospitals differed significantly in inpatient costs, length of stay, and time spent in the ICU.

"As the most prevalent chronic illness in children, asthma imposes a major financial burden on many healthcare systems," said study leader Jeffrey H. Silber, M.D., Ph.D., director of the Center for Outcomes Research at The Children's Hospital of Philadelphia, in a press release.

Silber and colleagues from CHOP and the Perelman School of Medicine at the University of Pennsylvania co-authored the study, published in JAMA Pediatrics.

For patients with a similar set of characteristics, researchers found that the median hospital costs varied by 87%, total length of stay varied by 47%, and ICU usage was 254% higher, all when comparing the lower eighth to the upper eighth of hospitals.

The research team analyzed data from nearly 49,000 children hospitalized for asthma at 37 major nonprofit U.S. children's hospitals in the Pediatric Health Information dataset. All the children were hospitalized between 2011 and 2014.

The study team used an analytical tool it developed called "template matching." The tool grouped patients by different characteristics to create templates that could be compared to matched patient templates derived from each hospital.

This matching system, according to Silber, allows hospital to audit their costs and resource use in a more refined way than simply reporting whether a hospital is more or less expensive in an aggregate fashion for a given diagnosis.

Patterns of resource use differed significantly across hospitals when classified by patient risk.

In some hospitals, costs for higher-risk patients were significantly higher compared to matched controls, while in other hospitals, those costs decreased as patient risk increased.

"If hospitals can better understand if their care practices are disproportionately expensive and inefficient compared to other hospitals, they may be better able to pinpoint opportunities for quality improvements," said Silber.

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