In an analysis of practice patterns at 37 major nonprofit U.S. children’s hospitals, researchers have found that intensive care unit (ICU) usage was 254% higher for asthma patients when comparing the lower eighth to the upper eighth of hospitals. The retrospective study was conducted by the Children’s Hospital of Philadelphia and the University of Pennsylvania’s Perelman School of Medicine.
Using three years of data from 48,887 children, the researchers constructed an asthma template consisting of representative children hospitalized for asthma between April 1, 2011, and March 31, 2014. Despite similar characteristics of the patients, the authors observed large and significant variation in the use of ICUs as well as in length of stay and cost.
“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, MD, PhD.
For the same template-matched populations, the investigators found that the median per-patient cost of asthma care varied by 87% ($3,157 vs. $5,912; P < 0.001) between the lower eighth and the upper eighth of hospitals. In addition, total hospital length of stay varied by 47% (1.5 days vs. 2.2 days; P < .001), and ICU utilization was 254% higher (6.5% vs. 23.0%; P < 0.001).
Moreover, the patterns of resource utilization by patient risk differed significantly across hospitals. For example, as patient risk increased, one hospital showed significantly increasing costs compared with matched controls (comparative cost difference: lowest risk, −34.2%; highest risk, +53.3%; P < 0.001). In contrast, another hospital displayed significantly decreasing costs relative to its matched controls as patient risk increased (comparative cost difference: lowest risk, −10.1%; highest risk, −16.9%; P = 0.01).
“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 said.
The study was published in JAMA Pediatrics.
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