US Pediatric Hospitals Vary Significantly in Care, Costs for Children with Asthma

US Pediatric Hospitals Vary Significantly in Care, Costs for Children with Asthma

Pediatric hospital costs and care vary significantly when it comes to children with asthma, according to researchers from the Center for Outcomes Research (COR) at Children’s Hospital of Philadelphia (CHOP).

The study “Auditing Practice Style Variation in Pediatric Inpatient Asthma Care,” was published July 11, in  JAMA Pediatrics.

The team evaluated data from Pediatric Health Information Services for nearly 49,000 children hospitalized for asthma at 37 major non-profit American children’s hospitals from 2011 to 2014. They found that even when asthma patients were grouped by characteristics like age or severity of illness, hospitals differed greatly in patient costs, duration 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 Dr. Jeffrey H. Silber, director of COR at CHOP, in a press release. “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.”

The study found that median costs varied 87 precent, total length of stay varied by 47 percent, and ICU usage was 254 percent higher when comparing the lower eight institutions to the upper eight. In addition, patterns of resource use varied significantly as well, when compared by patient risk. In some hospitals, costs for higher-risk patients were much higher in comparison to matched controls, while in other hospitals, the higher the risk, the lower the cost.

For the analysis, the team used a new tool they developed called ‘template matching’. The tool groups patients by different characteristics, to create templates that can then be compared to matched patient templates, all derived from each different hospital. According to Dr. Silber, the system allows hospitals to audit costs and resource use in a more refined way than just reporting if a hospital is more costly or less costly in an aggregate way, for a particular diagnosis.

In an online editorial, Dr. Jay Berry, of Boston Children’s Hospital, said Silber and his team “devised a way to systematically match and compare apples with other apples and then oranges with other oranges.”

Silber said the auditing method could help hospitals identify practice styles that need improvement.

“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,” Silber said.

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