Health Care Charges Research Articles

New outcome-specific comorbidity scores excelled in predicting in-hospital mortality and healthcare charges in administrative databases

ObjectivesTo determine the most reliable comorbidity measure, we adapted and validated outcome-specific comorbidity scores to predict mortality and hospital charges using the comorbidities composing the Charlson and Elixhauser measures and the combination of these two used in developing Gagne's combined comorbidity scores (CC, EC, and GC, respectively). Study Design and SettingWe divided cases of patients discharged in 2016–17 from the Diagnosis Procedure Combination database (n = 2,671,749) into two: one to derive weights for the scores, and the other for validation. We further validated them in subgroups, such as that with a selected diagnosis. ResultsThe c-statistics of the models predicting in-hospital mortality using new mortality scores using the CC, EC, and GC were 0.780, 0.795, and 0.794, respectively. Among them, that using the EC showed the best calibration. To predict hospital charges and the length of hospital stay (LOS), the models using variables indicating the GC performed the best. The performances of the mortality and expenditure scores were considerably different in predicting each outcome. ConclusionThe new score using the EC performed the best in predicting in-hospital mortality for most situations. For hospital charges and the LOS, the binary variables of the GC showed the best results. The outcome-specific comorbidity scores should be considered for different outcomes.

4256 Association Between Injury Intent and Emergency Department and Hospital Charges for Pediatric Firearm Injuries in the United States

OBJECTIVES/GOALS: In 2016, more than 3,100 children died, and an estimated 17,000 children had non-fatal injuries, from firearms in the United States. In this study, we used hospital charges as a proxy for medical resource utilization, and compared differences in charges by intent of firearm injury among children. METHODS/STUDY POPULATION: In this cross-sectional study of the 2016 Nationwide Emergency Department Sample, we identified firearm injury cases among children aged 19 years or younger using ICD-10-CM external cause of morbidity codes. Injury intent was characterized as unintentional, assault, self-inflicted, undetermined, or due to legal intervention. We included patients treated and released from the emergency department (ED) or admitted alive to the hospital, and excluded those who were transferred or died in the ED. We used linear regressions with survey weighting to compare differences in mean healthcare charges by firearm injury intent, with and without adjustment for ED disposition. RESULTS/ANTICIPATED RESULTS: Among 12,469 cases in the weighted sample, mean age was 16.5 years, a majority were male (88.2%) and Medicaid-insured (57.8%), and 64% were discharged from the ED and 36% admitted. Injuries were 49.0% unintentional, 45.1% assault-related, and 1.8% self-inflicted. Compared to children with self-inflicted injuries (charges $115,224), children with assault-related injuries (charges $55,052; p<0.007) and unintentional injuries (charges $38,643; p<0.001) had lower mean charges per visit. Differences in charges were no longer significant after adjusting for ED disposition, as 85.8% of self-inflicted injuries were admitted, compared to 46.5% of assault-related and 24.3% of unintentional injuries. DISCUSSION/SIGNIFICANCE OF IMPACT: Although the majority of pediatric firearm-related injuries resulting in emergency department care are unintentional or assault-related, self-inflicted injuries result in greater per visit hospital charges, attributable to higher hospitalization rates, and likely due to more severe injuries.

Tu1165 CHARACTERIZATION AND FINANCIAL BURDEN OF PATIENTS WITH INADEQUATE AND INCOMPLETE BOWEL PREP AT AN ACADEMIC TERTIARY CENTER-- A PILOT STUDY

Bowel prep is inadequate in one third of all inpatient colonoscopies even after educational interventions and regimen variations. Incomplete intake of bowel prep by inpatients may go unrecognized by the gastroenterologist until the procedure date, creating unnecessary delays and extending hospital admission and/or requiring repeat colonoscopy. Focusing on nausea, prep quantity consumed and need for delay, we aimed to identify modifiable risk factors for inadequate bowel prep, and estimated the burden to the healthcare system of suboptimal inpatient bowel prep. We prospectively collected data for all inpatient colonoscopies in a tertiary center from July-November 2019. We excluded patients who prepped via feeding tube or with planned extended prep, and emergent colonoscopies. We collected demographics, amount of prep consumed, prep duration, nausea, antiemetic use, delays due to incomplete prep, and prep quality. We grouped patients by adequacy of prep, time to prep completion, and nausea. Avoidable charge estimates, obtained from www.healthcarebluebook.com and the hospital billing department, were calculated based on need for repeat colonoscopy (including technical and professional charges for colonoscopy with anesthesia) and avoidable admission days. We identified 74 colonoscopies that met inclusion criteria: 71 used polyethylene glycol (PEG) with electrolytes, and 3 PEG. 2 were canceled for prep intolerance. 16 (22%) patients had inadequate bowel prep. These patients accounted for nearly all incurred avoidable healthcare charges (Table 1). 9 (12%) patients required delay of ≥1 day for additional prep, totaling 12 extra admission days. 12 (17%) needed an extra half day. These 21 patients (Delay) had more nausea, lower prep quality and more inadequate prep (RR=4.05) despite consuming more prep, and incurred considerably more avoidable healthcare charges ($68,350 vs. $28,050) even while excluding the 12 half-day delays (Table 2). 12(17%) patients had nausea, 7 received antiemetics. These had high risk of delay (RR=2.5), trended to increased risk of inadequate prep, and incurred avoidable charges at a higher rate (Table 2). Antiemetic use did not improve outcomes. In a tertiary center, nearly one quarter of inpatients have inadequate bowel prep and 30% require cancellation or delay due to incomplete prep at scheduled procedure time. Over a 5-month period this created an estimated $96,400 of avoidable healthcare charges. Need for delay is an important risk factor for inadequate prep. Nausea is a risk factor for procedure delay and possibly for inadequate prep too. These are potentially modifiable risk factors. While this study does not show efficacy of antiemetics or delays for additional prep, further study of proactive and preemptive management of patients at risk for delay and inadequate prep is warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A quality improvement initiative to reduce cast transitions in a pediatric hospital.

A quality improvement protocol was implemented in a large tertiary care pediatric hospital to reduce the rate of transitions from emergency department (ED)-applied casts to another form of immobilization (waterproof cast, removable brace, or sling). The local standard of care prior to implementing this quality improvement project involved applying long-arm casts in the ED for children presenting with stable upper extremity injuries (those not requiring a reduction). We created a multidisciplinary quality improvement team with orthopedic and ED providers, as well as cast technicians, with the aim of reducing the transition rate of ED-applied casts in clinic by 50%. Multiple Plan-Do-Study-Act cycles were performed and data were evaluated monthly. Charge fees were determined to assess differences in costs between splints and casts. An independent samples t-test for equality of means was used to determine the ED length of stay of each group. Baseline data determined a cast transition rate of 59.9%. After implementing the quality improvement protocol, the cast transition rate was reduced to 25.0%, a 58% reduction. The length of stay in the ED for a patient receiving a splint as opposed to a cast was 26.2 ± 8.0 min shorter. The charge to a patient receiving a splint rather than an ED-applied cast was $291.25 less. In conclusion, implementation of a multidisciplinary quality improvement protocol resulted in a more than 50% reduction in the transition rate of ED-applied casts in the clinic. Furthermore, healthcare charges to families were reduced by nearly $130 000 annually after implementation of this protocol.

Burden of Norovirus in the United States, as Estimated Based on Administrative Data: Updates for Medically Attended Illness and Mortality, 2001-2015.

Up-to-date estimates of the burden of norovirus, a leading cause of acute gastroenteritis (AGE) in the United States, are needed to assess the potential value of norovirus vaccines in development. We aimed to estimate the rates, annual counts, and healthcare charges of norovirus-associated ambulatory clinic encounters, emergency department (ED) visits, hospitalizations, and deaths in the United States. We analyzed administrative data on AGE outcomes from 1 July 2001 through 30 June 2015. Data were sourced from IBM MarketScan Commercial and Medicare Supplemental Databases (ambulatory clinic and ED visits), the Healthcare Utilization Project National Inpatient Sample (hospitalizations), and the National Center for Health Statistics multiple-cause-of-mortality data (deaths). Outcome data (ambulatory clinic and ED visits, hospitalizations, or deaths) were summarized by month, age group, and setting. Healthcare charges were estimated based on insurance claims. Monthly counts of cause-unspecified gastroenteritis-associated outcomes were modeled as functions of cause-specified outcomes, and model residuals were analyzed to estimate norovirus-associated outcomes. Healthcare charges were estimated by applying average charges per cause-unspecified gastroenteritis encounter to the estimated number of norovirus encounters. We estimate 900 deaths (95% confidence interval [CI], 650-1100), 109 000 hospitalizations (95% CI, 80 000-145 000), 465 000 ED visits (95% CI, 348 000-610 000), and 2.3 million ambulatory clinic encounters (95% CI, 1.7-2.9 million) annually due to norovirus, with an associated $430-$740 million in healthcare charges. Norovirus causes a substantial health burden in the United States each year, and an effective vaccine could have important public health impact.

Peripheral Blood Eosinophilia and Long-term Severity in Pediatric-Onset Inflammatory Bowel Disease

Peripheral blood eosinophilia (PBE) is a biomarker of an aggressive multiyear natural history in adults with inflammatory bowel diseases (IBDs). Additionally, PBE at diagnosis is associated with higher disease activity in pediatric-onset IBD. We sought to determine if PBE can function as a biomarker of long-term disease severity in pediatric-onset IBD patients who are followed into adulthood. We analyzed a consented, prospective, natural history IBD registry at an adult tertiary center from 2009 to 2018. Prevalence of PBE was evaluated in both pediatric- and adult-onset IBD patients. Demographics, clinical characteristics, and health care utilization data were compared in patients with and without PBE. Among 2800 adult IBD patients, 23.4% had pediatric-onset disease. PBE was found in 34% of the pediatric-onset patients compared with 26.8% of the adult-onset IBD patients (P < 0.001). In the pediatric-onset IBD cohort, PBE was associated with higher rates of allergies (P < 0.0001), but not of asthma, allergic rhinitis, or primary sclerosing cholangitis. In the adult IBD patients with pediatric-onset disease, PBE was associated with higher rates of C-reactive protein elevation (P < 0.0001), erythrocyte sedimentation rate elevation (P < 0.0001), higher health care utilization, and higher average health care charges per year (P < 0.00001). Peripheral blood eosinophilia was more prevalent in adult IBD patients with pediatric-onset compared with adult-onset disease. Among all IBD patients with long-term follow-up, PBE defined a subgroup with more severe illness. These data suggest that PBE may be a biomarker for a high-risk subgroup with high cost trajectory and long-term severity in pediatric-onset IBD that persists into adulthood.

Rehospitalization rates, costs, and risk factors for inflammatory bowel disease: a 16-year nationwide study.

Aims:We aimed to describe the burden of rehospitalization in patients with inflammatory bowel disease (IBD), by evaluating rehospitalization rates, charges, and risk factors over 16 years.Methods:We performed a retrospective analysis of all hospital discharges with a primary diagnosis of IBD in public hospitals between 2000 and 2015 in mainland Portugal from the Central Administration of the Health System (ACSS)’s national registry. We collected data on patient, clinical, and healthcare charges. We used survival analysis to estimate the rate and risk factors of IBD-related rehospitalization.Results:We found that 33% (n = 15,931) of the IBD-related hospitalizations corresponded to rehospitalizations, which increased by 12% over 16 years. However, IBD rehospitalization rate per 100,000 IBD patients decreased 2.5-fold between 2003 and 2015. Mean IBD-related rehospitalization charges were €14,589/hospitalization-year in 2000 and €17,548 /hospitalization-year in 2015, with total rehospitalization charges reaching €3.1 million/year by 2015. Overall, the 30-day rate of rehospitalization was 24% for Crohn’s disease (CD) and 22.4% for ulcerative colitis (UC). Novel risk factors for rehospitalization include penetrating disease in CD patients {hazard ratio (HR) 1.34 [95% confidence interval (CI) 1.20–1.51], p < 0.001} and colostomy in UC patients [HR 2.84 (95% CI 1.06–7.58)].Conclusion:IBD-related rehospitalization should be closely monitored, and efforts to reduce its risk factors should be made to improve the quality of care and, consequently, to reduce the burden of IBD.

Clinical and economic analysis of patients with acute myeloid leukemia by FLT3 status and midostaurin use at a Comprehensive Cancer Center

IntroductionIdentification of cytogenetic and molecular abnormalities has become vital for the appropriate treatment of acute myeloid leukemia (AML). One of the most common molecular alterations in AML is the constitutive activation by internal tandem duplication of FMS-like tyrosine kinase 3 (FLT3). MethodsThis observational, retrospective, cohort study at the Huntsman Cancer Institute (HCI) had two time periods: 1) a historical pre-midostaurin time period which consisted of the FLT3 mutated (FLT3m) and FLT3 wild type (FLT3wt) cohorts from January 1, 2007, to December 31, 2016, and 2) a post-midostaurin cohort which consisted of the FLT3 mutated midostaurin-user cohort (early mido) from May 01, 2017 to December 31, 2018. ResultsIn total, 39 patients were included in the FLT3m cohort, 61 in the FLT3wt cohort, and seven in the early mido cohort. FLT3m patients spent fewer days in the hospital during the first consolidation regimen and received fewer consolidation cycles compared to FLT3wt patients. Overall survival (OS) was similar between FLT3m and FLT3wt patients. For patients without hematopoietic stem cell transplant, OS was significantly shorter for FLT3m patients compared to FLT3wt patients. Mean AML related inpatient charges and physician charges for FLT3m patients were significantly higher than FLT3wt patients. ConclusionThe FLT3 mutation is historically associated with a shorter time to transplant and increased total health care charges. More information is needed to evaluate the real-world treatment strategies for FLT3-mutated patients in the presence of FLT3 inhibitors and the impact of these treatment strategies on clinical and economic outcomes.

2901 Variation in Standard IBD Financial Charges Across Major U.S. Medical Systems

INTRODUCTION: Inflammatory bowel diseases (IBD) are costly chronic illnesses with routine services both inpatient and outpatient, preventative care, and costly biologic pharmaceuticals. Recent mandates require US hospitals to publish healthcare system financial charges. As many as 10-15% of IBD patients are uninsured and as such, are accountable for the entirety of their healthcare charges. We aimed to assess the variability in healthcare charges for standard tests and procedures routinely utilized in IBD care. METHODS: Financial charges from 25 geographically diverse healthcare systems were obtained and queried. Serum studies included metabolic, nutritional, inflammation, and infectious screening studies Stool studies included infectious testings and fecal calprotectin. Imaging studies included CT and MRI abdomen; endoscopy included EGD and colonoscopy with biopsy. Lab studies were divided into Basic (e.g., CBC, CMP, CRP) and Extended categories (e.g., EBV serology) to express differing views on the routine testing extent. Diagnosis-related groups for commonly billed encounters for IBD patients (DRG 329-331) were also examined. RESULTS: Most centers reported data on all serum, stool, and imaging studies queried; however, reporting on colonoscopy with biopsy (n = 14/25) and DRG charges (range 8-14) was inconsistent. There was significant variability in the charges for routine laboratory, imaging, and endoscopic evaluation across the healthcare systems (Figure 1). The median sum charge for Basic labs was $2,105 (IQR $1,576-3,522), Extended labs $4,596 (IQR $3,877-7,341), and rose to $9,671 (IQR $7677-12,051) and $13,085 (IQR $10,481-15,511) with the addition of CT plus colonoscopy, respectively. DRGs for inflammatory bowel disease demonstrated less variability (Figure 2). Median charge for IBD without complication or comorbidity was $64,268 (IQR $52,296-76,377), with complication/comorbidity $96,588 (IQR $71,962-109,674, and rose to $181,675 (IQR $133,962-235,744) with a major complication or comorbidity. The most inexpensive healthcare system averaged charges 65% below than the median, and the most costly averaged 232% higher. CONCLUSION: There is significant variability across healthcare systems in financial charges for commonly ordered tests and procedures in IBD patients that can reach staggering sums. Uniformity and transparency in healthcare pricing structures is desperately needed to ease the financial burden, particularly for uninsured populations.

741 Low Serum Levels of IgG4 Antibodies May Function as a Biomarker of Severity in Inflammatory Bowel Disease

INTRODUCTION: Immunoglobulin G subclass 4 (IgG4) is hypothesized to play an immunoregulatory role which effectively decreases humoral immune responses. The presence of high serum IgG4 levels is considered a biomarker for IgG4 related diseases. On the other hand, low levels of IgG4 have been reported mainly in infectious diseases but also in healthy individuals. The role of abnormal serum IgG4 in inflammatory bowel disease (IBD) has not been fully characterized. We sought to define alterations in serum IgG4 in IBD patients and its association with multiyear disease severity. METHODS: We analyzed a prospective, longitudinal IBD registry of consented patients followed at a tertiary center over a 10-year time period. IBD patients with IgG4 serum levels available formed the study population. Demographics and multiyear clinical data were collected and analyzed. Disease severity was approximated with patterns of healthcare utilization metadata. We compared IBD patients with low, normal or high serum IgG4 levels. RESULTS: There were 1213 IBD patients with IgG4 levels tested [females 54%, Crohn Disease (CD) 65%, Ulcerative Colitis (UC) 33%, IBD unclassified 2%, median age at diagnosis 25 years]. Low IgG4 levels were seen in 245 patients (20%) and elevated IgG4 levels occurred in 65 (5%). In univariate analysis, low IgG4 was associated with CD (P = 0.028) and lifetime IBD surgeries (P &lt; 0.001). During the 10-year observation period, low IgG4 patients had higher rates of new IBD surgeries (P = 0.012), office visits (P = 0.007), requirement for biologic agents (P = 0.009), steroid use (P = 0.021) and higher cumulative healthcare charges (P = 0.015) compared with normal IgG4 patients. In the multivariate analysis (MVA), low IgG4 was associated with IBD surgeries (P = 0.003) and requirement for biologic therapy (P = 0.017) during the 10-year period as well as higher rates of lifetime IBD surgery (P = 0.002). High IgG4 levels were associated with younger age (P = 0.006), male gender (P &lt; 0.001) and lower steroid use (P = 0.043) (univariate analysis) but were not associated with primary sclerosing cholangitis (P = 0.112); in MVA only male gender (P = 0.001) remained significant. CONCLUSION: Low IgG4 is four times more common than IgG4 elevation in IBD and is associated with multiple markers of disease severity. Further investigation is required to determine whether this finding represents the loss of a potential anti-inflammatory molecular mechanism which contributes to more severe illness in IBD.

Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Phoenix, Arizona, USA1.

We developed an electronic records methodology to programmatically estimate the date of first appearance of coccidioidomycosis symptoms in patients. We compared the diagnostic delay with overall healthcare utilization charges. Many patients (46%) had delays in diagnosis of >1 month. Billed healthcare charges before diagnosis increased with length of delay.

Cost-benefit analysis of VKA versus NOAC treatment in German patients with atrial fibrillation utilizing patient self-testing.

BackgroundClinical complications of long-term anticoagulation in patients with atrial fibrillation cause significant morbidity and have a substantial economic impact on the healthcare system.ObjectiveTo assess the cost-benefit by implementing patient self-testing (PST) in German patients anticoagulated with vitamin K antagonists (VKA) compared to treatment with the new oral anticoagulant drugs (NOAC) apixaban, dabigatran, edoxaban, and rivaroxaban.MethodsA deterministic decision-analytic model was developed simulating the number of major bleedings, ischemic strokes, and hemorrhagic strokes and their associated costs by utilizing PST compared to those of treatment with NOAC. Data on the rates of these adverse events in both groups during the 1st year of treatment was taken from the NOAC approval studies. Direct costs were evaluated from the perspective of the Statutory Health Insurance (SHI) considering the use of resources directly related to PST testing and costs incurred by hospital treatment of the adverse events. Univariate sensitivity analysis was performed to examine the extent to which our calculations were affected by varying the parameters considered in our model within plausible extremes. To capture the interactions between multiple inputs, we also provided a probabilistic sensitivity analysis (PSA).ResultsWhen achieving an average time in therapeutic range (TTR) of 78%, implementing PST in VKA patients reduces cost per patient compared to NOAC treatment between €603.38 [USD 681.52] (edoxaban) and €762.64 [USD 861.40] (rivaroxaban) during the 1-year observation period. In line with the TTR increase, the initially higher number of adverse events per VKA patient compared to NOACtreated patients in the approval studies becomes largely aligned; the difference in associated hospital costs per patient in the NOAC groups is then only €1.03 [USD 1.16] (in favor of dabigatran), €23.41 [USD 26.44] (in favor of apixaban), €0.53 [USD 0.60] (in favor of edoxaban) and €52.62 [USD 59.43] (in favor of VKA anticoagulation in the rivaroxaban group).In PSA, implementation of self-management results on average in a cost saving between €619.20 [USD 699.39] and €785.24 [USD 886.93] per VKA patient in favor of the SHI. Under all reasonable assumptions, PST remains constantly less expensive irrespective of which NOAC is administered.ConclusionImplementing PST in German VKA patients may significantly reduce SHI expenditures compared to utilizing NOAC.

The Burden of Hypoxic Respiratory Failure in Preterm and Term/Near-term Infants in the United States 2011-2015.

ObjectivesThis study quantified the burden of hypoxic respiratory failure (HRF)/persistent pulmonary hypertension of newborn (PPHN) in preterm and term/near-term infants (T/NTs) by examining health care resource utilization (HRU) and charges in the United States.MethodsPreterms and T/NTs (≤34 and >34 weeks of gestation, respectively) having HRF/PPHN, with/without meconium aspiration in inpatient setting from January 1, 2011–October 31, 2015 were identified from the Vizient database (first hospitalization=index hospitalization). Comorbidities, treatments, HRU, and charges during index hospitalization were evaluated among preterms and T/NTs with HRF/PPHN. Logistic regression was performed to evaluate mortality-related factors.ResultsThis retrospective study included 504 preterms and 414 T/NTs with HRF/PPHN. Preterms were more likely to have respiratory distress syndrome, neonatal jaundice, and anemia of prematurity than T/NTs. Preterms had significantly longer inpatient stays (54.1 vs 29.0 days), time in a neonatal intensive care unit (34.1 vs 17.5 days), time on ventilation (4.7 vs 2.2 days), and higher total hospitalization charges ($613 350 vs $422 558) (all P<0.001). Similar rates were observed for use of antibiotics (96.2% vs 95.4%), sildenafil (9.5% vs 8.2%), or inhaled nitric oxide (93.8% vs 94.2%). Preterms had a significantly higher likelihood of mortality than T/NTs (odds ratio: 3.6, 95% confidence interval: 2.3–5.0).ConclusionsThe findings of more severe comorbidities, higher HRU, hospitalization charges, and mortality in preterms than in T/NTs underscore the significant clinical and economic burden of HRF/PPHN among infants. The results show significant unmet medical need; further research is warranted to determine new treatments and real-world evidence for improved patient outcomes.

The Burden of Hypoxic Respiratory Failure in Preterm and Term/Near-term Infants in the United States 2011-2015

Objectives: This study quantified the burden of hypoxic respiratory failure (HRF)/persistent pulmonary hypertension of newborn (PPHN) in preterm and term/near-term infants (T/NTs) by examining health care resource utilization (HRU) and charges in the United States. Methods: Preterms and T/NTs (≤34 and &gt;34 weeks of gestation, respectively) having HRF/PPHN, with/without meconium aspiration in inpatient setting from January 1, 2011-October 31, 2015 were identified from the Vizient database (first hospitalization=index hospitalization). Comorbidities, treatments, HRU, and charges during index hospitalization were evaluated among preterms and T/NTs with HRF/PPHN. Logistic regression was performed to evaluate mortality-related factors. Results: This retrospective study included 504 preterms and 414 T/NTs with HRF/PPHN. Preterms were more likely to have respiratory distress syndrome, neonatal jaundice, and anemia of prematurity than T/NTs. Preterms had significantly longer inpatient stays (54.1 vs 29.0 days), time in a neonatal intensive care unit (34.1 vs 17.5 days), time on ventilation (4.7 vs 2.2 days), and higher total hospitalization charges ($613,350 vs $422,558) (all P&lt;0.001). Similar rates were observed for use of antibiotics (96.2% vs 95.4%), sildenafil (9.5% vs 8.2%), or inhaled nitric oxide (93.8% vs 94.2%). Preterms had a significantly higher likelihood of mortality than T/NTs (odds ratio: 3.6, 95% confidence interval: 2.3-5.0). Conclusions: The findings of more severe comorbidities, higher HRU, hospitalization charges, and mortality in preterms than in T/NTs underscore the significant clinical and economic burden of HRF/PPHN among infants. The results show significant unmet medical need; further research is warranted to determine new treatments and real-world evidence for improved patient outcomes.

The Burden of Hypoxic Respiratory Failure in Preterm and Term/Near-term Infants in the United States 2011-2015

Objectives: This study quantified the burden of hypoxic respiratory failure (HRF)/persistent pulmonary hypertension of newborn (PPHN) in preterm and term/near-term infants (T/NTs) by examining health care resource utilization (HRU) and charges in the United States. Methods: Preterms and T/NTs (≤34 and &gt;34 weeks of gestation, respectively) having HRF/PPHN, with/without meconium aspiration in inpatient setting from January 1, 2011-October 31, 2015 were identified from the Vizient database (first hospitalization=index hospitalization). Comorbidities, treatments, HRU, and charges during index hospitalization were evaluated among preterms and T/NTs with HRF/PPHN. Logistic regression was performed to evaluate mortality-related factors. Results: This retrospective study included 504 preterms and 414 T/NTs with HRF/PPHN. Preterms were more likely to have respiratory distress syndrome, neonatal jaundice, and anemia of prematurity than T/NTs. Preterms had significantly longer inpatient stays (54.1 vs 29.0 days), time in a neonatal intensive care unit (34.1 vs 17.5 days), time on ventilation (4.7 vs 2.2 days), and higher total hospitalization charges ($613,350 vs $422,558) (all P&lt;0.001). Similar rates were observed for use of antibiotics (96.2% vs 95.4%), sildenafil (9.5% vs 8.2%), or inhaled nitric oxide (93.8% vs 94.2%). Preterms had a significantly higher likelihood of mortality than T/NTs (odds ratio: 3.6, 95% confidence interval: 2.3-5.0). Conclusions: The findings of more severe comorbidities, higher HRU, hospitalization charges, and mortality in preterms than in T/NTs underscore the significant clinical and economic burden of HRF/PPHN among infants. The results show significant unmet medical need; further research is warranted to determine new treatments and real-world evidence for improved patient outcomes.

Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore

ObjectiveTo evaluate the impact on healthcare utilisation frequencies and charges, and mortality of a programme for frequent hospital utilisers and a programme for patients requiring high acuity post-discharge care as...

Tu2051 – Candidate and Exploratory Genetic Association Study of IBD Severity Using a Novel Phenotype (Multiyear Mean Healthcare Charges)

Tu2051 – Candidate and Exploratory Genetic Association Study of IBD Severity Using a Novel Phenotype (Multiyear Mean Healthcare Charges)

Ordering Patterns and Costs of Specialized Laboratory Testing by Hospitalists and House Staff in Hospitalized Patients With HIV at a County Hospital: An Opportunity for Diagnostic Stewardship.

BackgroundInpatient HIV care often requires specialized laboratory testing with which practitioners may not be familiar. In addition, computerized physician order entry allows for ordering tests without understanding test indications, but it can also provide a venue for education and diagnostic stewardship.MethodsAll charts of HIV-positive patients hospitalized at a tertiary care public safety net hospital in Houston, Texas, between January 1, 2014, and June 30, 2014, were reviewed for a set list of laboratory tests. Appropriateness of test ordering was assessed by 2 providers. Cost estimates for each test were obtained from Medicaid and a national nonprofit health care charge database.ResultsA total of 274 HIV-positive patients were admitted 429 times in the 6-month study period. During the study period, 45% of the study laboratory tests ordered were not indicated. A total of 532 hepatitis serologies were ordered, only 52% of which were indicated. Overall, 71 serum qualitative cytomegalovirus (CMV) polymerase chain reactions (PCRs) and eight CMV quantitative PCRs were ordered, with most (85%) qualitative PCRs ordered for nonspecific signs of infection (eg, fever). Other tests ordered without clear indications included Aspergillus IgE (7), serum Epstein-Barr virus (EBV) PCR (5), parvovirus serology (7), and Toxoplasma IgM (18). Overall, the estimated laboratory cost of inappropriate testing over the study period was between $14 000 and $92 000, depending on which cost database was used.ConclusionsMany tests ordered in HIV-positive inpatients do not have indications, representing a substantial source of health care waste and cost and potentially leading to inappropriate treatment. Opportunities exist to decrease waste through education of trainees and hospitalists and through implementation of diagnostic stewardship via the electronic medical record.

Cost analysis of intraoperative neural monitoring

The recurrent laryngeal nerve (RLN) injury represents one of the most feared complications during thyroidectomy (1). These injuries may cause a temporary or permanent palsy of the RLN and occur, more frequently, monolaterally. If only one side is involved, the palsy results in voice changes, hoarseness, or breathing trouble; in bilateral cases, instead, patients can undergo a potentially fatal airway obstruction needing an urgent tracheostomy (1). This complication, affects the quality of life of the patients, increases the charges for health care, and is the most frequent plea of lawsuits against thyroid surgeons.

Clinical Research Using the National Inpatient Sample: A Brief Review of Colorectal Studies Utilizing the NIS Database.

The National Inpatient Sample (NIS) is the largest collection of longitudinal hospital care data in the United States and is sponsored by the Agency for Healthcare Research and Quality. The data are collected from state organizations, hospital associations, private organizations, and the federal government. This database has been used in more than 400 disease-focused studies to examine health care utilization, access, charges, quality, and outcomes of care. The database has been maintained since 1988, making it one of the oldest on hospital data. The focus of this review is to explore and discuss the use of NIS database in colorectal surgery research and to formulate a simplified guide of the data captured for future researchers.