ABSTRACT
OBJECTIVES: To determine the relative role that academic hospitals (AHs) play in providing neonatal care for low-birth-weight infants within a single state and to determine if there are variations in inpatient costs for neonatal services among AHs. DESIGN: Retrospective analysis of hospital costs for low-birth-weight infants. SETTING: Cases were identified using 2003-2005 data from the Tennessee Hospital Discharge Data System. A specific focus was discharge data from the 5 AHs that support obstetrical residencies and have a neonatal intensive care unit. PARTICIPANTS: Cases included all discharged infants with a birth weight of <2500 grams. RESULTS: The 5 AHs discharged 18% of the total normal-birth-weight infants and 30% of the low-birth-weight infants for the entire state. AHs had higher costs associated with these infants than did other hospitals, with a single exception The difference in costs at this hospital was consistent with the finding of lower utilization rates of hospital services, a shorter average length of stay, and lower costs for infants insured by the state Medicaid program. CONCLUSION: Academic obstetrical hospitals discharged a disproportionately high percentage of low-birth-weight infants compared with other Tennessee hospitals. The lower costs observed in the Shelby County hospital indicates that other hospitals could potentially lower their costs for the care of low-birth-weight infants.
Subject(s)
Academic Medical Centers/economics , Critical Care/economics , Hospital Costs , Infant Care/economics , Infant, Low Birth Weight , Intensive Care Units, Neonatal/economics , Birth Weight , Cost-Benefit Analysis , Critical Care/methods , Databases, Factual , Female , Gestational Age , Hospital Mortality/trends , Humans , Infant Mortality/trends , Infant, Newborn , Infant, Very Low Birth Weight , Length of Stay/economics , Male , Pregnancy , Probability , Reference Values , Retrospective Studies , Risk Factors , United StatesABSTRACT
BACKGROUND: Potentially avoidable pediatric hospitalizations (PAPH) can now be identified using an analytical tool developed by the federal Agency for Healthcare Research and Quality (AHRQ). We apply this new tool to Tennessee inpatient discharge records for 2005 to determine the prevalence of PAPH and analyze the variation patterns of PAPH across racial, gender, and insurance status lines. METHODS: Retrospective analysis of administrative data based on the UB-92 claims forms submitted by all short-term acute-care hospitals in Tennessee for 2005. RESULTS: Tennessee had higher prevalence rates of PAPH than seen in the nation overall for four of the five Ambulatory-Care Sensitive Conditions (ACSC), identified by AHRQ as those hospitalizations which can potentially be avoided. Variations of the rates of PAPH across racial, gender and insurance subgroups were found to mirror those found for pediatric hospitalizations for all conditions. However, when PAPH were grouped according to whether they were chronic or acute in terms of their primary admitting condition, Black children were over-represented in PAPH for chronic conditions such as asthma and diabetes. In addition, Black children's average costs are significantly higher than those for White children irrespective of whether the admitting condition was chronic or acute. CONCLUSIONS: The high rates of PAPH reported in this study imply a weakness in Tennessee's primary care for children. These high rates also point out opportunities for reducing expensive hospitalizations associated with poorly controlled diabetes, asthma exacerbations, and dehydration due to gastroenteritis.
