Intercenter Cost Variation for Perinatal Hypoxic-Ischemic Encephalopathy in the Era of Therapeutic Hypothermia

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• 作者：An N. Massaro ; MD¹ ; ^{anguyenm@childrensnational.org" class="auth_mail" title="E-mail the corresponding author} ; Karna Murthy ; MD ; MSc² ; ³ ; Isabella Zaniletti ; PhD⁴ ; Noah Cook ; MD ; MTR⁵ ; Robert DiGeronimo ; MD⁶ ; Maria L.V. Dizon ; MD ; MSc² ; Shannon E.G. Hamrick ; MD⁷ ; Victor J. McKay ; MD⁸ ; Girija Natarajan ; MD⁹ ; Rakesh Rao ; MD¹⁰ ; Troy Richardson ; MS ; MPH ; PhD⁴ ; Danielle Smith ; MD¹¹ ; Amit M. Mathur ; MD¹⁰ ; on behalf of the Children's Hospital Neonatal Consortium^&lowast ; ; Francine Dykes ; MD ; Anthony Piazza ; MD ; Gregory Sysyn ; MD ; Carl Coghill ; MD ; Ramasubbareddy Dhanireddy ; MD ; Anne Hansen ; MD ; Tanzeema Hossain ; MBChB ; Karna Murthy ; MD ; MSc ; Kristina Reber ; MD ; Rashmin Savani ; MD ; Luc Brion ; MD ; Theresa Grover ; MD ; Girija Natarajan ; MD ; Annie Chi ; MD ; Yvette Johnson ; MD ; Gautham Suresh ; MD ; Eugenia Pallotto ; MD ; Becky Rodgers ; MD ; Robert Lyle ; MD ; Steven Chin ; MD ; Priscilla Joe ; MD ; Arthur D'Harlingue ; MD ; Jacquelyn Evans ; MD ; Michael Padula ; MD ; MBI ; Beverly Brozanski ; MD ; Amit Mathur ; MD ; Rakesh Rao ; MD ; Victor McKay ; MD ; Mark Speziale ; MD ; Billie Short ; MD ; Kevin Sullivan ; MD ; Robert Di Geronimo ; MD ; Michael Uhing ; MD ; Kathleen Meskin ; RN ; BSN ; Lisa Jentsch ; RN ; MBA ; John Grebe ; MD ; Rajan Wadhawan ; MD ; Elizabeth Jacobson ; MD ; Jeanette Asselin ; David Durand ; Francine Dykes ; Jacquelyn Evans (Chair) ; Karna Murthy ; Michael Padula ; Eugenia Pallotto ; Kristina Reber ; Billie Lou Short
• 关键词：newborn ; hypothermia ; neonatal intensive care unit ; intercenter variation ; cost
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：173
• 期：Complete
• 页码：76-83.e1
• 全文大小：780 K

文摘

To quantify intercenter cost variation for perinatal hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals.

Study design

Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes.

Results

Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86%) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29% of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs.

Conclusions

There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.