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Hospital Care Cost and Resource Use of Early Discharge of Healthy Late Preterm and Term Singletons: A Population-based Cohort Study and Cost Analysis
To assess the hospital care cost and resource use associated with discharge timings after late preterm and term births. This population-based cohort study and cost analysis included all healthy singleton late preterm (35-36 weeks gestational age) and term infants (37-41 weeks gestational age) born v...
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| Published in: | The Journal of pediatrics 2020-11, Vol.226, p.96-105.e7 |
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| Main Authors: | , , , , , |
| Format: | Article |
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| cited_by | cdi_FETCH-LOGICAL-c359t-d7ef533f7fa650fb37591c56d14b1f634ad9cbedaedf17018ee29f55ae79fc4b3 |
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| cites | cdi_FETCH-LOGICAL-c359t-d7ef533f7fa650fb37591c56d14b1f634ad9cbedaedf17018ee29f55ae79fc4b3 |
| container_end_page | 105.e7 |
| container_issue | |
| container_start_page | 96 |
| container_title | The Journal of pediatrics |
| container_volume | 226 |
| creator | Isayama, Tetsuya O'Reilly, Daria Beyene, Joseph Shah, Prakesh S. Lee, Shoo K. McDonald, Sarah D. |
| description | To assess the hospital care cost and resource use associated with discharge timings after late preterm and term births.
This population-based cohort study and cost analysis included all healthy singleton late preterm (35-36 weeks gestational age) and term infants (37-41 weeks gestational age) born vaginally in hospitals in Ontario, Canada, from 2003 to 2012. Early, late, and very late discharge ( |
| doi_str_mv | 10.1016/j.jpeds.2020.06.060 |
| format | article |
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This population-based cohort study and cost analysis included all healthy singleton late preterm (35-36 weeks gestational age) and term infants (37-41 weeks gestational age) born vaginally in hospitals in Ontario, Canada, from 2003 to 2012. Early, late, and very late discharge (<48, 48-71, and 72-95 hours after birth, respectively) were compared using generalized linear models. The primary outcome was the total hospital care cost (hospitalizations and emergency department visits) per infant within 28 days of birth.
Among 860 693 singletons (3.7% late preterm), early discharge increased significantly over 10 years for term infants (from 69% to 82%; P < .001), but not late preterm infants (from 32% to 35%; P = .75). The mean total cost within 28 days after birth was not significantly different for late preterm infants between early discharge and late discharge after adjustment. However, for term infants, the adjusted cost was higher with early discharge than late discharge (aMCD $311 [95% CI, $211-$412] per infant; $366 [95% CI, $355-$377] per mother-infant dyad). The neonatal readmission rates were higher after early than late discharge for late preterm and term infants.
Early discharge was not associated with cost savings for vaginally born healthy singleton late preterm infants, and instead was associated with a cost increase for term infants. Early discharge was associated with higher neonatal readmission rates. Individualized approach balancing the risk and benefit is appropriate to determine the discharge timings.</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2020.06.060</identifier><identifier>PMID: 32610167</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cohort Studies ; Cost Savings ; Emergency Service, Hospital - economics ; Emergency Service, Hospital - statistics & numerical data ; Facilities and Services Utilization ; Female ; Gestational Age ; health care costs ; Hospital Costs - statistics & numerical data ; Hospitalization - economics ; Hospitalization - statistics & numerical data ; Humans ; Infant, Newborn ; Infant, Premature ; length of stay ; Male ; newborn infants ; Ontario ; patient readmission</subject><ispartof>The Journal of pediatrics, 2020-11, Vol.226, p.96-105.e7</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-d7ef533f7fa650fb37591c56d14b1f634ad9cbedaedf17018ee29f55ae79fc4b3</citedby><cites>FETCH-LOGICAL-c359t-d7ef533f7fa650fb37591c56d14b1f634ad9cbedaedf17018ee29f55ae79fc4b3</cites><orcidid>0000-0002-3669-883X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32610167$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Isayama, Tetsuya</creatorcontrib><creatorcontrib>O'Reilly, Daria</creatorcontrib><creatorcontrib>Beyene, Joseph</creatorcontrib><creatorcontrib>Shah, Prakesh S.</creatorcontrib><creatorcontrib>Lee, Shoo K.</creatorcontrib><creatorcontrib>McDonald, Sarah D.</creatorcontrib><title>Hospital Care Cost and Resource Use of Early Discharge of Healthy Late Preterm and Term Singletons: A Population-based Cohort Study and Cost Analysis</title><title>The Journal of pediatrics</title><addtitle>J Pediatr</addtitle><description>To assess the hospital care cost and resource use associated with discharge timings after late preterm and term births.
This population-based cohort study and cost analysis included all healthy singleton late preterm (35-36 weeks gestational age) and term infants (37-41 weeks gestational age) born vaginally in hospitals in Ontario, Canada, from 2003 to 2012. Early, late, and very late discharge (<48, 48-71, and 72-95 hours after birth, respectively) were compared using generalized linear models. The primary outcome was the total hospital care cost (hospitalizations and emergency department visits) per infant within 28 days of birth.
Among 860 693 singletons (3.7% late preterm), early discharge increased significantly over 10 years for term infants (from 69% to 82%; P < .001), but not late preterm infants (from 32% to 35%; P = .75). The mean total cost within 28 days after birth was not significantly different for late preterm infants between early discharge and late discharge after adjustment. However, for term infants, the adjusted cost was higher with early discharge than late discharge (aMCD $311 [95% CI, $211-$412] per infant; $366 [95% CI, $355-$377] per mother-infant dyad). The neonatal readmission rates were higher after early than late discharge for late preterm and term infants.
Early discharge was not associated with cost savings for vaginally born healthy singleton late preterm infants, and instead was associated with a cost increase for term infants. Early discharge was associated with higher neonatal readmission rates. Individualized approach balancing the risk and benefit is appropriate to determine the discharge timings.</description><subject>Cohort Studies</subject><subject>Cost Savings</subject><subject>Emergency Service, Hospital - economics</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Facilities and Services Utilization</subject><subject>Female</subject><subject>Gestational Age</subject><subject>health care costs</subject><subject>Hospital Costs - statistics & numerical data</subject><subject>Hospitalization - economics</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>length of stay</subject><subject>Male</subject><subject>newborn infants</subject><subject>Ontario</subject><subject>patient readmission</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9UV1r3DAQFKWluaT9BYWix774urL8ERf6cFyTXuGgoUmehSytcjp0livJBf-Q_t_avrSPhYVdlpkdZoeQdwzWDFj18bg-9qjjOocc1lBNBS_IikFTZ9U15y_JCiDPM17U1QW5jPEIAE0B8Jpc8LyaT9Qr8nvnY2-TdHQrA9Ktj4nKTtMfGP0QFNLHiNQbeiODG-kXG9VBhqdltUPp0mGke5mQ3gVMGE4L92Ee7m335DD5Ln6iG3rn-8HJZH2XtTKinoQOPiR6nwY9LqRFedNJN0Yb35BXRrqIb5_7FXm8vXnY7rL996_ftpt9pnjZpEzXaErOTW1kVYJpeV02TJWVZkXLTMULqRvVopaoDauBXSPmjSlLiXVjVNHyK_LhfLcP_ueAMYnT5BCdkx36IYq8YE3NSgYwQfkZqoKPMaARfbAnGUbBQMzPFEex5CHmPARUU82s988CQ3tC_Y_zN4AJ8PkMwMnmL4tBRGWxU6htQJWE9va_An8A_kiexg</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Isayama, Tetsuya</creator><creator>O'Reilly, Daria</creator><creator>Beyene, Joseph</creator><creator>Shah, Prakesh S.</creator><creator>Lee, Shoo K.</creator><creator>McDonald, Sarah D.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3669-883X</orcidid></search><sort><creationdate>202011</creationdate><title>Hospital Care Cost and Resource Use of Early Discharge of Healthy Late Preterm and Term Singletons: A Population-based Cohort Study and Cost Analysis</title><author>Isayama, Tetsuya ; O'Reilly, Daria ; Beyene, Joseph ; Shah, Prakesh S. ; Lee, Shoo K. ; McDonald, Sarah D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-d7ef533f7fa650fb37591c56d14b1f634ad9cbedaedf17018ee29f55ae79fc4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Cohort Studies</topic><topic>Cost Savings</topic><topic>Emergency Service, Hospital - economics</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Facilities and Services Utilization</topic><topic>Female</topic><topic>Gestational Age</topic><topic>health care costs</topic><topic>Hospital Costs - statistics & numerical data</topic><topic>Hospitalization - economics</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infant, Premature</topic><topic>length of stay</topic><topic>Male</topic><topic>newborn infants</topic><topic>Ontario</topic><topic>patient readmission</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Isayama, Tetsuya</creatorcontrib><creatorcontrib>O'Reilly, Daria</creatorcontrib><creatorcontrib>Beyene, Joseph</creatorcontrib><creatorcontrib>Shah, Prakesh S.</creatorcontrib><creatorcontrib>Lee, Shoo K.</creatorcontrib><creatorcontrib>McDonald, Sarah D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Isayama, Tetsuya</au><au>O'Reilly, Daria</au><au>Beyene, Joseph</au><au>Shah, Prakesh S.</au><au>Lee, Shoo K.</au><au>McDonald, Sarah D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hospital Care Cost and Resource Use of Early Discharge of Healthy Late Preterm and Term Singletons: A Population-based Cohort Study and Cost Analysis</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>2020-11</date><risdate>2020</risdate><volume>226</volume><spage>96</spage><epage>105.e7</epage><pages>96-105.e7</pages><issn>0022-3476</issn><eissn>1097-6833</eissn><abstract>To assess the hospital care cost and resource use associated with discharge timings after late preterm and term births.
This population-based cohort study and cost analysis included all healthy singleton late preterm (35-36 weeks gestational age) and term infants (37-41 weeks gestational age) born vaginally in hospitals in Ontario, Canada, from 2003 to 2012. Early, late, and very late discharge (<48, 48-71, and 72-95 hours after birth, respectively) were compared using generalized linear models. The primary outcome was the total hospital care cost (hospitalizations and emergency department visits) per infant within 28 days of birth.
Among 860 693 singletons (3.7% late preterm), early discharge increased significantly over 10 years for term infants (from 69% to 82%; P < .001), but not late preterm infants (from 32% to 35%; P = .75). The mean total cost within 28 days after birth was not significantly different for late preterm infants between early discharge and late discharge after adjustment. However, for term infants, the adjusted cost was higher with early discharge than late discharge (aMCD $311 [95% CI, $211-$412] per infant; $366 [95% CI, $355-$377] per mother-infant dyad). The neonatal readmission rates were higher after early than late discharge for late preterm and term infants.
Early discharge was not associated with cost savings for vaginally born healthy singleton late preterm infants, and instead was associated with a cost increase for term infants. Early discharge was associated with higher neonatal readmission rates. Individualized approach balancing the risk and benefit is appropriate to determine the discharge timings.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32610167</pmid><doi>10.1016/j.jpeds.2020.06.060</doi><orcidid>https://orcid.org/0000-0002-3669-883X</orcidid></addata></record> |
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| language | eng |
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| source | Elsevier:Jisc Collections:Elsevier Read and Publish Agreement 2022-2024:Freedom Collection (Reading list) |
| subjects | Cohort Studies Cost Savings Emergency Service, Hospital - economics Emergency Service, Hospital - statistics & numerical data Facilities and Services Utilization Female Gestational Age health care costs Hospital Costs - statistics & numerical data Hospitalization - economics Hospitalization - statistics & numerical data Humans Infant, Newborn Infant, Premature length of stay Male newborn infants Ontario patient readmission |
| title | Hospital Care Cost and Resource Use of Early Discharge of Healthy Late Preterm and Term Singletons: A Population-based Cohort Study and Cost Analysis |
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