Variations in length of stay and cost of pediatric pneumonia hospitalizations according to patient and institutional factors.

BACKGROUND

There have been consistent reports on variation in the treatment of pediatric pneumonia. In Korea, healthcare institutions are categorized into four types according to inpatient capacity and patient acuity: tertiary general hospitals (≥500 beds), general hospitals (100-499 beds), hospitals (30-99 beds), and clinics (<30 beds). We sought to examine the length of stay and cost for all-cause pediatric pneumonia across these different types of healthcare institutions.

METHODS

We conducted a retrospective, observational study of all cases of pediatric inpatients aged 18 and under who were hospitalized for pneumonia between 2010 and 2019 using claim data. Pneumonia was defined based on the claim diagnosis. The trends of length of stay and cost over the years were analyzed using linear regression. A multilevel analysis was conducted at two hierarchical levels (individual and institutional). Results are presented from the unadjusted baseline model (Model 1) to the fully adjusted model (Model 4), which accounted for both individual and institutional factors, with primary emphasis on Model 4.

RESULTS

Among the 2 921 096 cases, hospitals accounted for the largest proportion of hospitalization, with a total of 1 389 925 cases (47.58%) (P < .0001). The average length of stay for pneumonia cases was 5.77 days (SD 5.96) and hospitals had the longest average stay at 5.85 days (SD 7.59) (P < .0001). The average cost for pneumonia hospitalizations was $125.11 (SD 45.13), with tertiary general hospitals having the highest average cost at $159.20 (SD 73.30) (P < .0001). In the fully adjusted model (Model 4), the intra-class correlation (ICC) for length of stay attributed to -healthcare institutions ranged from 20.43 to 35.61. Clinics had the highest ICC for length of stay, with ranges from 43.07 to 52.64. For hospitalization costs, the ICC for healthcare institutions ranged from 53.39 to 70.78. Hospitals had highest ICC values for hospitalization costs, ranging from 65.82 to 84.07.

CONCLUSION

Substantial variation exists in the length of stay and costs for pediatric pneumonia hospitalizations across different types of healthcare institutions. This variation was particularly pronounced in hospitals and clinics. To enhance the quality of pneumonia care and reduce this variability, policy interventions such as the promotion of clinical guidelines and institutional quality assessments are necessary.