Nav: Home

US pediatric hospitals vary greatly in costs, practices for children with asthma

July 12, 2016

Children's hospitals vary greatly in managing inpatients with asthma, according to researchers who analyzed hospital records in a large national database. Even when patients were grouped by characteristics such as age or severity of illness, hospitals differed significantly in inpatient costs, length of stay, and time spent in the intensive care unit (ICU).

"As the most prevalent chronic illness in children, asthma imposes a major financial burden on many health care 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 (CHOP). "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."

Silber and colleagues from CHOP and the Perelman School of Medicine at the University of Pennsylvania co-authored a study that appeared online July 11 in JAMA Pediatrics.

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 during 2011 to 2014.

The study team used a new analytical tool they developed called "template matching." That tool grouped patients by different characteristics to create templates that could be compared to matched patient templates derived from each hospital. This matching system, said Silber, allows hospital to audit their costs and resource use in a more refined way than simply reporting if a hospital is more or less expensive in an aggregate fashion for a given diagnosis.

In an online editorial in JAMA Pediatrics commenting on the study, Dr. Jay Berry of Boston Children's Hospital said that Silber and colleagues "devised a way to systematically match and compare apples with other apples and then oranges with other oranges."

The authors note that template matching enables administrators to understand a hospital's resource use at the patient level, and allows them to investigate practice differences by asking questions such as, does their hospital use ICUs as often as matched controls? Or are there great differences in the choices of medications prescribed for similar patients?

In the current study, the researchers found that for patients with a similar set of characteristics, median cost varied by 87 percent, total length of stay varied by 47 percent, and ICU usage was 254 percent higher, all when comparing the lower eighth to the upper eighth of hospitals.

In addition, 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.

"Although there are well-established clinical pathways for treating children with asthma, we found significant differences in how tertiary-care pediatric hospitals used their resources," said Silber. "However, this auditing method offers hospitals some guidance in identifying practice styles that could improve their care."
-end-
The Agency for Healthcare Research and Quality (grant HS020508) supported this research. Co-authors with Silber were Paul R. Rosenbaum, PhD; Wei Wang, PhD; Shawna Calhoun, MPH; James P. Guevara, MD, MPH; Joseph J. Zorc, MD, MSCE; Ashley Zeigler, BA, and Orit Even-Shoshan, MS.

Jeffrey H. Silber et al, "Auditing Practice Style Variation in Pediatric Inpatient Asthma Care," JAMA Pediatrics, published online July 11, 2016. http://doi.org/10.1001/jamapediatrics.2016.0911

About The Children's Hospital of Philadelphia: The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 535-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu

Children's Hospital of Philadelphia

Related Asthma Articles:

Breastfeeding and risks of allergies and asthma
In an Acta Paediatrica study, exclusive breastfeeding for the first 3 months was linked with a lower risk of respiratory allergies and asthma when children reached 6 years of age.
Researchers make asthma breakthrough
Researchers from Trinity College Dublin have made a breakthrough that may eventually lead to improved therapeutic options for people living with asthma.
Physics vs. asthma
A research team from the MIPT Center for Molecular Mechanisms of Aging and Age-Related Diseases has collaborated with colleagues from the U.S., Canada, France, and Germany to determine the spatial structure of the CysLT1 receptor.
New knowledge on the development of asthma
Researchers at Karolinska Institutet in Sweden have studied which genes are expressed in overactive immune cells in mice with asthma-like inflammation of the airways.
Eating fish may help prevent asthma
A scientist from James Cook University in Australia says an innovative study has revealed new evidence that eating fish can help prevent asthma.
Academic performance of urban children with asthma worse than peers without asthma
A new study published in Annals of Allergy, Asthma and Immunology shows urban children with poorly controlled asthma, particularly those who are ethnic minorities, also suffer academically.
Asthma Controller Step Down Yardstick -- treatment guidance for when asthma improves
The focus for asthma treatment is often stepping up treatment, but clinicians need to know how to step down therapy when symptoms improve.
Asthma management tools improve asthma control and reduce hospital visits
A set of comprehensive asthma management tools helps decrease asthma-related visits to the emergency department, urgent care or hospital and improves patients' asthma control.
Asthma linked to infertility but not among women taking regular asthma preventers
Women with asthma who only use short-acting asthma relievers take longer to become pregnant than other women, according to research published in the European Respiratory Journal.
What are the best ways to diagnose and manage asthma?
A team of experts from The University of Texas Medical Branch at Galveston examined the current information available from many different sources on diagnosing and managing mild to moderate asthma in adults and summarized them.
More Asthma News and Asthma Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.