Barradas Danielle T, Wasserman Martin P, Daniel-Robinson Lekisha, Bruce Marino A, DiSantis Katherine Isselmann, Navarro Frederick H, Jones Warren A, Manzi Nadine M, Smith Mark W, Goodness Brian M
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-74, Atlanta, GA, 30341, USA.
Provider Resources, Inc. Healthcare Quality and Disparities Division, Erie, PA, USA.
Matern Child Health J. 2016 Apr;20(4):808-18. doi: 10.1007/s10995-015-1911-y.
To describe hospital utilization and costs associated with preterm or low birth weight births (preterm/LBW) by payer prior to implementation of the Affordable Care Act and to identify areas for improvement in the quality of care received among preterm/LBW infants.
Hospital utilization-defined as mean length of stay (LOS, days), secondary diagnoses for birth hospitalizations, primary diagnoses for rehospitalizations, and transfer status-and costs were described among preterm/LBW infants using the 2009 Nationwide Inpatient Sample.
Approximately 9.1 % of included hospitalizations (n = 4,167,900) were births among preterm/LBW infants; however, these birth hospitalizations accounted for 43.4 % of total costs. Rehospitalizations of all infants occurred at a rate of 5.9 % overall, but accounted for 22.6 % of total costs. This pattern was observed across all payer types. The prevalence of rehospitalizations was nearly twice as high among preterm/LBW infants covered by Medicaid (7.6 %) compared to commercially-insured infants (4.3 %). Neonatal transfers were more common among preterm/LBW infants whose deliveries and hospitalizations were covered by Medicaid (7.3 %) versus commercial insurance (6.5 %). Uninsured/self-pay preterm and LBW infants died in-hospital during the first year of life at a rate of 91 per 1000 discharges-nearly three times higher than preterm and LBW infants covered by either Medicaid (37 per 1000) or commercial insurance (32 per 1000).
When comparing preterm/LBW infants whose births were covered by Medicaid and commercial insurance, there were few differences in length of hospital stays and costs. However, opportunities for improvement within Medicaid and CHIP exist with regard to reducing rehospitalizations and neonatal transfers.
描述在《平价医疗法案》实施之前，按支付方划分的早产或低出生体重儿（早产/低体重儿）的住院情况及相关费用，并确定早产/低体重儿所接受护理质量的改进领域。
利用2009年全国住院患者样本，对早产/低体重儿的住院情况（定义为平均住院时长（住院天数）、出生住院的次要诊断、再次住院的主要诊断以及转诊状态）和费用进行描述。
纳入的住院病例中约9.1%（n = 4,167,900）为早产/低体重儿出生；然而，这些出生住院病例占总费用的43.4%。所有婴儿的再次住院率总体为5.9%，但占总费用的22.6%。这种模式在所有支付方类型中均有观察到。与商业保险覆盖的婴儿（4.3%）相比，医疗补助覆盖的早产/低体重儿再次住院率几乎高出一倍（7.6%）。在医疗补助覆盖分娩和住院的早产/低体重儿中，新生儿转诊更为常见（7.3%），而商业保险覆盖的为6.5%。未参保/自费的早产和低体重儿在出生后第一年的院内死亡率为每1000例出院91例，几乎是医疗补助（每1000例37例）或商业保险（每1000例32例）覆盖的早产和低体重儿的三倍。
在比较医疗补助和商业保险覆盖出生的早产/低体重儿时，住院时长和费用方面差异不大。然而，在医疗补助和儿童健康保险计划（CHIP）中，在减少再次住院和新生儿转诊方面仍有改进空间。
