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Hospital factors associated with increased LOS, costs for infants with bronchiolitis

BALTIMORE — Location-teaching status and region were linked to an increased length of stay and cost for infants hospitalized with bronchiolitis, recent data presented at the Pediatric Academic Societies Meeting indicated.

“Variation in resource utilization is a widespread problem for bronchiolitis, a leading cause of hospitalization of young children,” Alyssa H. Silver, MD, from the division of pediatric hospital medicine at Children’s Hospital at Montefiore, told Infectious Diseases in Children. “Our study utilized the 2012 Agency for Healthcare Research and Quality Healthcare Cost and the Utilization Project Kids’ Inpatient Database (KID), the only all-payer inpatient care database (which includes rural and nonteaching hospitals) for children in the United States.”

Alyssa H. Silver

The researchers performed a cross-sectional analysis of 61,425 hospital discharges of children aged younger than 2 years with bronchiolitis. Severity measures and cost-to-charge ratios data were combined.

Silver and colleagues used sampling design and discharge weights to evaluate the data. Length of stay (LOS) and cost was log transformed, due to non-normal distribution. In addition, multivariate linear regression with the antilog was performed.

“Nationally, LOS and cost were higher in urban teaching hospitals compared to rural hospitals by 14% and 17%, respectively, even when adjusted for other patient and hospital level factors, including APR-DRG severity scores and number of complex chronic conditions,” Silver said. “Surprisingly, while there is significant regional variation in LOS, cost was only significantly higher in the West (37%) compared to the Northeast.”

Results showed that 83.1% of patients were aged younger than 1 year at admission, 57.1% were male, 64.3% had Medicaid, 83.1% had no chronic conditions, and 64.3% were admitted to urban teaching hospitals. The mean LOS was 3.05 days (95% CI, 2.99-3.1), mean total charges were $16,384 (95% CI, 15,481-17,286), and average cost was $4,913 (95% CI, 4,638-5,186).

“Possible explanations for these findings include teaching hospitals performing more testing for academic purposes, trainees waiting longer to discharge patients, or the severity of illness not being accounted for in coding data,” Silver said. “Despite the existence of guidelines, significant variation in resource utilization for inpatient bronchiolitis still exists. Identification of hospital-level factors associated with variation may help target dissemination of guidelines, practice parameters or organizational changes aiming to uniformly deliver high-quality care for children hospitalized with bronchiolitis.” – by Alaina Tedesco

Reference:

Silver AH, et al. Abstract 1487.310. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.

Disclosure: The researchers report no relevant financial disclosures.