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

David Alan Danford, Quentin Karels, Aparna Kulkarni, Aysha Hussain, Yunbin Xiao, Shelby Kutty

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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∈;lt0.0001). BC were greater among inpatient deaths than among patients discharged alive (median 4.09∈;times10;bsupesup vs. 1.63∈;times10;bsupesup, p∈;lt0.0001). 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.

Original languageEnglish (US)
Article number137
JournalOrphanet Journal of Rare Diseases
Volume10
Issue number1
DOIs
StatePublished - Oct 22 2015

Fingerprint

Hypoplastic Left Heart Syndrome
Inpatients
Mortality
Length of Stay
Hospitalization
Health Information Systems
Fatal Outcome
Survival
Patient Admission
Health Expenditures
Databases
Pediatrics

Keywords

  • Congenital heart disease
  • Hypoplastic left heart syndrome
  • Mortality-related resource utilization fraction
  • Outcomes
  • Pediatric cardiology

ASJC Scopus subject areas

  • Genetics(clinical)
  • Pharmacology (medical)

Cite this

Mortality-related resource utilization in the inpatient care of hypoplastic left heart syndrome. / Danford, David Alan; Karels, Quentin; Kulkarni, Aparna; Hussain, Aysha; Xiao, Yunbin; Kutty, Shelby.

In: Orphanet Journal of Rare Diseases, Vol. 10, No. 1, 137, 22.10.2015.

Research output: Contribution to journalArticle

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abstract = "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∈;lt0.0001). BC were greater among inpatient deaths than among patients discharged alive (median 4.09∈;times10;bsupesup vs. 1.63∈;times10;bsupesup, p∈;lt0.0001). 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.",
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