Intercenter cost variation for perinatal hypoxic-ischemic encephalopathy in the era of therapeutic hypothermia

An N. Massaro, Karna Murthy, Isabella Zaniletti, Noah Cook, Robert DiGeronimo, Maria L V Dizon, Shannon E G Hamrick, Victor J. McKay, Girija Natarajan, Rakesh Rao, Troy Richardson, Danielle Smith, Amit M. Mathur, Francine Dykes, Anthony Piazza, Gregory Sysyn, Carl Coghill, Ramasubbareddy Dhanireddy, Anne Hansen, Tanzeema HossainKristina Reber, Rashmin Savani, Luc Brion, Theresa Grover, Annie Chi, Yvette Johnson, Gautham Suresh, Eugenia Pallotto, Becky Rodgers, Robert Lyle, Steven Chin, Priscilla Joe, Arthur D'Harlingue, Jacquelyn Evans, Michael Padula, Beverly Brozanski, Mark Speziale, Billie Short, Kevin Sullivan, Robert Di Geronimo, Michael Uhing, Kathleen Meskin, Lisa Jentsch, John Grebe, Rajan Wadhawan, Elizabeth Jacobson, Jeanette Asselin, David Durand, Billie Lou Short

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective To quantify intercenter cost variation for perinatal hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals. Study design Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes. Results Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86%) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29% of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs. Conclusions There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.

Original languageEnglish (US)
Pages (from-to)76-83.e1
JournalJournal of Pediatrics
Volume173
DOIs
StatePublished - Jun 1 2016

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Brain Hypoxia-Ischemia
Induced Hypothermia
Costs and Cost Analysis
Electroencephalography
Hospitalization
Health Information Systems
Neonatal Intensive Care Units
Enteral Nutrition
Mechanical Ventilators
Quality Improvement
Neuroimaging
Intensive Care Units
Survivors

Keywords

  • cost
  • hypothermia
  • intercenter variation
  • neonatal intensive care unit
  • newborn

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Massaro, A. N., Murthy, K., Zaniletti, I., Cook, N., DiGeronimo, R., Dizon, M. L. V., ... Short, B. L. (2016). Intercenter cost variation for perinatal hypoxic-ischemic encephalopathy in the era of therapeutic hypothermia. Journal of Pediatrics, 173, 76-83.e1. https://doi.org/10.1016/j.jpeds.2016.02.033

Intercenter cost variation for perinatal hypoxic-ischemic encephalopathy in the era of therapeutic hypothermia. / Massaro, An N.; Murthy, Karna; Zaniletti, Isabella; Cook, Noah; DiGeronimo, Robert; Dizon, Maria L V; Hamrick, Shannon E G; McKay, Victor J.; Natarajan, Girija; Rao, Rakesh; Richardson, Troy; Smith, Danielle; Mathur, Amit M.; Dykes, Francine; Piazza, Anthony; Sysyn, Gregory; Coghill, Carl; Dhanireddy, Ramasubbareddy; Hansen, Anne; Hossain, Tanzeema; Reber, Kristina; Savani, Rashmin; Brion, Luc; Grover, Theresa; Chi, Annie; Johnson, Yvette; Suresh, Gautham; Pallotto, Eugenia; Rodgers, Becky; Lyle, Robert; Chin, Steven; Joe, Priscilla; D'Harlingue, Arthur; Evans, Jacquelyn; Padula, Michael; Brozanski, Beverly; Speziale, Mark; Short, Billie; Sullivan, Kevin; Di Geronimo, Robert; Uhing, Michael; Meskin, Kathleen; Jentsch, Lisa; Grebe, John; Wadhawan, Rajan; Jacobson, Elizabeth; Asselin, Jeanette; Durand, David; Short, Billie Lou.

In: Journal of Pediatrics, Vol. 173, 01.06.2016, p. 76-83.e1.

Research output: Contribution to journalArticle

Massaro, AN, Murthy, K, Zaniletti, I, Cook, N, DiGeronimo, R, Dizon, MLV, Hamrick, SEG, McKay, VJ, Natarajan, G, Rao, R, Richardson, T, Smith, D, Mathur, AM, Dykes, F, Piazza, A, Sysyn, G, Coghill, C, Dhanireddy, R, Hansen, A, Hossain, T, Reber, K, Savani, R, Brion, L, Grover, T, Chi, A, Johnson, Y, Suresh, G, Pallotto, E, Rodgers, B, Lyle, R, Chin, S, Joe, P, D'Harlingue, A, Evans, J, Padula, M, Brozanski, B, Speziale, M, Short, B, Sullivan, K, Di Geronimo, R, Uhing, M, Meskin, K, Jentsch, L, Grebe, J, Wadhawan, R, Jacobson, E, Asselin, J, Durand, D & Short, BL 2016, 'Intercenter cost variation for perinatal hypoxic-ischemic encephalopathy in the era of therapeutic hypothermia', Journal of Pediatrics, vol. 173, pp. 76-83.e1. https://doi.org/10.1016/j.jpeds.2016.02.033
Massaro, An N. ; Murthy, Karna ; Zaniletti, Isabella ; Cook, Noah ; DiGeronimo, Robert ; Dizon, Maria L V ; Hamrick, Shannon E G ; McKay, Victor J. ; Natarajan, Girija ; Rao, Rakesh ; Richardson, Troy ; Smith, Danielle ; Mathur, Amit M. ; Dykes, Francine ; Piazza, Anthony ; Sysyn, Gregory ; Coghill, Carl ; Dhanireddy, Ramasubbareddy ; Hansen, Anne ; Hossain, Tanzeema ; Reber, Kristina ; Savani, Rashmin ; Brion, Luc ; Grover, Theresa ; Chi, Annie ; Johnson, Yvette ; Suresh, Gautham ; Pallotto, Eugenia ; Rodgers, Becky ; Lyle, Robert ; Chin, Steven ; Joe, Priscilla ; D'Harlingue, Arthur ; Evans, Jacquelyn ; Padula, Michael ; Brozanski, Beverly ; Speziale, Mark ; Short, Billie ; Sullivan, Kevin ; Di Geronimo, Robert ; Uhing, Michael ; Meskin, Kathleen ; Jentsch, Lisa ; Grebe, John ; Wadhawan, Rajan ; Jacobson, Elizabeth ; Asselin, Jeanette ; Durand, David ; Short, Billie Lou. / Intercenter cost variation for perinatal hypoxic-ischemic encephalopathy in the era of therapeutic hypothermia. In: Journal of Pediatrics. 2016 ; Vol. 173. pp. 76-83.e1.
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abstract = "Objective To quantify intercenter cost variation for perinatal hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals. Study design Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes. Results Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86{\%}) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29{\%} of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs. Conclusions There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.",
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T1 - Intercenter cost variation for perinatal hypoxic-ischemic encephalopathy in the era of therapeutic hypothermia

AU - Massaro, An N.

AU - Murthy, Karna

AU - Zaniletti, Isabella

AU - Cook, Noah

AU - DiGeronimo, Robert

AU - Dizon, Maria L V

AU - Hamrick, Shannon E G

AU - McKay, Victor J.

AU - Natarajan, Girija

AU - Rao, Rakesh

AU - Richardson, Troy

AU - Smith, Danielle

AU - Mathur, Amit M.

AU - Dykes, Francine

AU - Piazza, Anthony

AU - Sysyn, Gregory

AU - Coghill, Carl

AU - Dhanireddy, Ramasubbareddy

AU - Hansen, Anne

AU - Hossain, Tanzeema

AU - Reber, Kristina

AU - Savani, Rashmin

AU - Brion, Luc

AU - Grover, Theresa

AU - Chi, Annie

AU - Johnson, Yvette

AU - Suresh, Gautham

AU - Pallotto, Eugenia

AU - Rodgers, Becky

AU - Lyle, Robert

AU - Chin, Steven

AU - Joe, Priscilla

AU - D'Harlingue, Arthur

AU - Evans, Jacquelyn

AU - Padula, Michael

AU - Brozanski, Beverly

AU - Speziale, Mark

AU - Short, Billie

AU - Sullivan, Kevin

AU - Di Geronimo, Robert

AU - Uhing, Michael

AU - Meskin, Kathleen

AU - Jentsch, Lisa

AU - Grebe, John

AU - Wadhawan, Rajan

AU - Jacobson, Elizabeth

AU - Asselin, Jeanette

AU - Durand, David

AU - Short, Billie Lou

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Objective To quantify intercenter cost variation for perinatal hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals. Study design Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes. Results Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86%) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29% of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs. Conclusions There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.

AB - Objective To quantify intercenter cost variation for perinatal hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals. Study design Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes. Results Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86%) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29% of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs. Conclusions There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.

KW - cost

KW - hypothermia

KW - intercenter variation

KW - neonatal intensive care unit

KW - newborn

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