Health outcomes and the healthcare and societal cost of optimizing pediatric surgical care in the United States.
Adolescent
Child
Child, Preschool
Databases, Factual
Female
Health Care Costs
/ statistics & numerical data
Health Resources
Hospitalization
/ economics
Hospitals
/ statistics & numerical data
Humans
Infant
Inpatients
Length of Stay
/ economics
Male
Postoperative Complications
/ economics
Program Evaluation
/ methods
Surgical Procedures, Operative
/ economics
Treatment Outcome
United States
Epidemiology
Healthcare costs
Outcomes
Pediatric surgery
Verification
Journal
Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
19
02
2018
revised:
21
10
2018
accepted:
26
10
2018
pubmed:
2
1
2019
medline:
21
5
2019
entrez:
2
1
2019
Statut:
ppublish
Résumé
There is a movement to ensure that pediatric patients are treated in appropriately resourced hospitals through the ACS Children's Surgery Verification (CSV) program. The objective of this study was to assess the potential difference in care provision, health outcomes and healthcare and societal costs after implementation of the CSV program. All 2011 inpatient admissions for selected complex pediatric patients warranting treatment at a hospital with Level I resources were evaluated across 6 states. Multivariate regressions were used to analyze differences in healthcare outcomes (postoperative complications including death, length of stay, readmissions and ED visits within 30 days) and costs by CSV level. Recycled predictions were used to estimate differences between the base case scenario, where children actually received care, and the optimized scenario, where all children were theoretically treated at Level I centers. 8,006 children (mean age 3.06 years, SD 4.49) met inclusion criteria, with 45% treated at Level I hospitals, 30% at Level II and 25% at Level III. No statistically significant differences were observed in healthcare outcomes. Readmissions within 30 days were higher at Level II compared to Level I centers (adjusted IRR 1.61; 95% CI 1.11, 2.34), with an estimated 24 avoidable readmissions per 1000 children if treatment were shifted from Level II to Level I centers. Overall, costs per child were not significantly different between the base case and the optimized scenario. Many complex surgical procedures are being performed at Level II/III centers. This study found no statistically significant increase in healthcare or societal costs if these were performed instead at Level I centers under the optimized scenario. Ongoing evaluation of efforts to match institutional resources with individual patient needs is needed to optimize children's surgical care in the United States. II.
Sections du résumé
BACKGROUND
BACKGROUND
There is a movement to ensure that pediatric patients are treated in appropriately resourced hospitals through the ACS Children's Surgery Verification (CSV) program. The objective of this study was to assess the potential difference in care provision, health outcomes and healthcare and societal costs after implementation of the CSV program.
METHODS
METHODS
All 2011 inpatient admissions for selected complex pediatric patients warranting treatment at a hospital with Level I resources were evaluated across 6 states. Multivariate regressions were used to analyze differences in healthcare outcomes (postoperative complications including death, length of stay, readmissions and ED visits within 30 days) and costs by CSV level. Recycled predictions were used to estimate differences between the base case scenario, where children actually received care, and the optimized scenario, where all children were theoretically treated at Level I centers.
RESULTS
RESULTS
8,006 children (mean age 3.06 years, SD 4.49) met inclusion criteria, with 45% treated at Level I hospitals, 30% at Level II and 25% at Level III. No statistically significant differences were observed in healthcare outcomes. Readmissions within 30 days were higher at Level II compared to Level I centers (adjusted IRR 1.61; 95% CI 1.11, 2.34), with an estimated 24 avoidable readmissions per 1000 children if treatment were shifted from Level II to Level I centers. Overall, costs per child were not significantly different between the base case and the optimized scenario.
CONCLUSION
CONCLUSIONS
Many complex surgical procedures are being performed at Level II/III centers. This study found no statistically significant increase in healthcare or societal costs if these were performed instead at Level I centers under the optimized scenario. Ongoing evaluation of efforts to match institutional resources with individual patient needs is needed to optimize children's surgical care in the United States.
LEVEL OF EVIDENCE
METHODS
II.
Identifiants
pubmed: 30598246
pii: S0022-3468(18)30763-2
doi: 10.1016/j.jpedsurg.2018.10.102
pmc: PMC6511280
mid: NIHMS1523827
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
621-627Subventions
Organisme : NICHD NIH HHS
ID : T32 HD057822
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
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