Mortality-related resource utilization in the inpatient care of hypoplastic left heart syndrome

Orphanet Journal of Rare Diseases

Shelby Kutty²  Yunbin Xiao²  Aysha Hussain²  Aparna Kulkarni¹  Quentin Karels²  David A. Danford² 

[1] Division of Pediatric Cardiology, Albert Einstein College of Medicine, Bronx, NY, USA;University of Nebraska Medical Center and Children’s Hospital and Medical Center, 8200 Dodge St, Omaha 68114, NE, USA

关键词: Outcomes;    Mortality-related resource utilization fraction;    Congenital heart disease;    Pediatric cardiology;    Hypoplastic left heart syndrome;   

Others  :  1230403
DOI  :  10.1186/s13023-015-0355-1

 received in 2015-08-21, accepted in 2015-10-16,  发布年份 2015

【 摘 要 】

Background

Quantifying resource utilization in the inpatient care of congenital heart diease is clinically relevant. Our purpose is to measure the investment of inpatient care resources to achieve survival in hypoplastic left heart syndrome (HLHS), and to determine how much of that investment occurs in hospitalizations that have a fatal outcome, the mortality-related resource utilization fraction (MRRUF).

Methods

A collaborative administrative database, the Pediatric Health Information System (PHIS) containing data for 43 children’s hospitals, was queried by primary diagnosis for HLHS admissions of patients ≤21 years old during 2004–2013. Institution, patient age, inpatient deaths, billed charges (BC) and length of stay (LOS) were recorded.

Results

In all, 11,122 HLHS admissions were identified which account for total LOS of 277,027 inpatient-days and $3,928,794,660 in BC. There were 1145 inpatient deaths (10.3 %). LOS was greater among inpatient deaths than among patients discharged alive (median 17 vs. 12, p < 0.0001). BC were greater among inpatient deaths than among patients discharged alive (median 4.09 × 10 ⁵vs. 1.63 × 10 ⁵ , p < 0.0001). 16 % of all LOS and 21 % of all BC were accrued by patients who did not survive their hospitalization. These proportions showed no significant change year-by-year. The highest volume institutions had lower mortality rates, but there was no relation between institutional volume and the MRRUF.

Conclusions

These data should alert providers and consumers that current practices often result in major resource expenditure for inpatient care of HLHS that does not result in survival to hospital dismissal. They highlight the need for data-driven critical review of standard practices to identify patterns of care associated with success, and to modify approaches objectively.

【 授权许可】

   
2015 Danford et al.

【 图 表 】

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