Johnson Joyce T, Sullivan Kirsen L, Nelson Richard E, Sheng Xiaoming, Greene Tom H, Bailly David K, Eckhauser Aaron W, Marino Bradley S, Minich L LuAnn, Pinto Nelangi M
Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Statistics, Purdue University, West Lafayette, IN.
Pediatr Crit Care Med. 2020 Sep;21(9):e842-e847. doi: 10.1097/PCC.0000000000002507.
We leveraged decomposition analysis, commonly used in labor economics, to understand determinants of cost differences related to location of admission in children undergoing neonatal congenital heart surgery.
A retrospective cohort study.
Pediatric Health Information Systems database.
Neonates (<30 d old) undergoing their index congenital heart surgery between 2004 and 2013.
A decomposition analysis with bootstrapping determined characteristic (explainable by differing covariate levels) and structural effects (if covariates are held constant) related to cost differences. Covariates included center volume, age at admission, prematurity, sex, race, genetic or major noncardiac abnormality, Risk Adjustment for Congenital Heart Surgery-1 score, payor, admission year, cardiac arrest, infection, and delayed sternal closure.Of 19,984 infants included (10,491 [52%] to cardiac ICU/PICU and 9,493 [48%] to neonatal ICU), admission to the neonatal ICU had overall higher average costs ($24,959 ± $3,260; p < 0.001) versus cardiac ICU/PICU admission. Characteristic effects accounted for higher costs in the neonatal ICU ($28,958 ± $2,044; p < 0.001). Differing levels of prematurity, genetic syndromes, hospital volume, age at admission, and infection contributed to higher neonatal ICU costs, with infection rate providing the most significant contribution ($13,581; p < 0.001). Aggregate structural effects were not associated with cost differences for those admitted to the neonatal ICU versus cardiac ICU/PICU (p = 0.1). Individually, prematurity and age at admission were associated with higher costs due to structural effects for infants admitted to the neonatal ICU versus cardiac ICU/PICU.
The difference in cost between neonatal ICU and cardiac ICU/PICU admissions is largely driven by differing prevalence of risk factors between these units. Infection rate was a modifiable factor that accounted for the largest difference in costs between admitting units.
我们运用劳动经济学中常用的分解分析方法，以了解新生儿先天性心脏病手术患儿因入院地点不同导致费用差异的决定因素。
一项回顾性队列研究。
儿科健康信息系统数据库。
2004年至2013年间接受首次先天性心脏病手术的新生儿（<30日龄）。
采用自抽样法进行分解分析，确定与费用差异相关的特征效应（可由不同协变量水平解释）和结构效应（若协变量保持不变）。协变量包括中心手术量、入院年龄、早产情况、性别、种族、遗传或主要非心脏异常、先天性心脏病手术风险调整-1评分、支付方、入院年份、心脏骤停、感染及胸骨延迟闭合。纳入的19984例婴儿中（10491例[52%]入住心脏重症监护病房/儿科重症监护病房，9493例[48%]入住新生儿重症监护病房），与入住心脏重症监护病房/儿科重症监护病房相比，入住新生儿重症监护病房的总体平均费用更高（24959美元±3260美元；p<0.001）。特征效应导致新生儿重症监护病房费用更高（28958美元±2044美元；p<0.001）。早产、遗传综合征、医院手术量、入院年龄及感染情况的不同导致新生儿重症监护病房费用更高，其中感染率的影响最为显著（13581美元；p<0.001）。新生儿重症监护病房与心脏重症监护病房/儿科重症监护病房入院患者的总体结构效应与费用差异无关（p = 0.1）。单独来看，早产和入院年龄因结构效应导致入住新生儿重症监护病房的婴儿相比入住心脏重症监护病房/儿科重症监护病房的婴儿费用更高。
新生儿重症监护病房与心脏重症监护病房/儿科重症监护病房入院费用的差异主要由这些病房之间危险因素的不同患病率所致。感染率是一个可改变的因素，在不同入院病房的费用差异中占比最大。
