Hospital Charges of Potentially Preventable Pediatric Hospitalizations

• Published in: Academic pediatrics 2012-09, Vol.12 (5), p.436-444
• Main Authors: Lu, Sam, MD, MS, Kuo, Dennis Z., MD, MHS
• Format: Article
• Language: English
• Subjects: Adolescent; Ambulatory Care - economics; Ambulatory Care - utilization; ambulatory care-sensitive conditions; Asthma - economics; Child; Child, Preschool; Emergency Service, Hospital - economics; Female; hospital charges; Hospital Charges - statistics & numerical data; Hospitalization - economics; Humans; Infant; Infant, Newborn; Kids' Inpatient Database; Length of Stay - economics; Male; Minority Groups - statistics & numerical data; Multivariate Analysis; Neonatal and Perinatal Medicine; Pediatrics; Pediatrics - economics; Pneumonia - economics; preventable hospitalizations; Severity of Illness Index; Sex Factors; United States
• ISSN: 1876-2859; 1876-2867
• DOI: 10.1016/j.acap.2012.06.006

Abstract Objectives Reducing the number of preventable hospitalizations represents a possible source of health care savings. However, the current literature lacks a description of the extent of potentially preventable pediatric hospitalizations. The study objectives are to (1) identify the charges and (2) demographic characteristics associated with potentially preventable pediatric hospitalizations. Methods Secondary analysis of the 2006 Kids' Inpatient Database (weighted N = 7,558,812). International Classification of Diseases, Ninth Revision, Clinical Modification codes for 16 previously validated pediatric ambulatory care-sensitive (ACS) conditions identified potentially preventable hospitalizations; seven additional conditions reflected updated care guidelines. Outcome variables included number of admissions, hospitalization days, and hospital charges. Demographic and diagnostic variables associated with an ACS condition were compared with regression analyses by the use of appropriate person-level weights. Results Pediatric ACS hospitalizations totaled $4.05B in charges and 1,087,570 hospitalization days in 2006. Two respiratory conditions—asthma and bacterial pneumonia—comprised 48.4% of ACS hospital charges and 46.7% of ACS hospitalization days. In multivariate analysis, variables associated with an ACS condition included: male gender (odds ratio [OR] 1.10; 95% confidence interval [95% CI] 1.07–1.13); race/ethnicity of black (OR 1.22; 95% CI 1.16–1.27) or Hispanic (OR 1.12; 95% CI 1.06–1.18); and emergency department as admission source (OR 1.37; 95% CI 1.27–1.48). Conclusions Respiratory conditions comprised the largest proportion of potentially preventable pediatric hospitalizations, totaling as much as $1.96B in hospital charges. Children hospitalized with an ACS condition tend to be male, non-white, and admitted through the emergency department. Future research to prevent pediatric hospitalizations should examine targeted interventions in the primary care setting, specifically around respiratory conditions and minority populations.