Resources and Costs Associated With Repeated Admissions to PICUs.

• Type of Material: Article
• Authors: Jason M. Kane, University of Chicago, Department of Pediatrics, Section of Critical Care Medicine, Comer Children's Hospital, Chicago, IL.; Matt Hall, Children's Hospital Association, Lenexa, KS.; Cara Cecil, Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.; Vicki L. Montgomery, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY.; Lauren C. Rakes, Seattle Children's Hospital, University of Washington, Seattle, WA.; Colin Rogerson, Riley Hospital for Children, Indiana University, Indianapolis, IN.; Jana Stockwell, Emory University; Katherine N. Slain, UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH.; Denise M. Goodman, Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
• Language: English
• Date: 2021-02
• Publisher: Society of Critical Care Medicine
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/CCE.0000000000000347
• Title of Journal or Parent Work: Critical Care Explorations
• Volume: 3
• Issue: 2
• Start Page: e0347
• End Page: e0347
• Grant/Funding Information: None declared
• Keywords: intensive care units, pediatric; healthcare costs; patient readmission
• Research Categories: Health Sciences, Health Care Management

Abstract

Objective: To determine the costs and hospital resource use from all PICU patients readmitted with a PICU stay within 12 months of hospital index discharge. Design: Cross-sectional, retrospective cohort study using Pediatric Health Information System. Setting: Fifty-two tertiary children’s hospitals. Subjects: Pediatric patients under 18 years old admitted to the PICU from January 1, 2016, to December 31, 2017. Interventions: None. Measurements and Main Results: Patient characteristics and costs of care were compared between those with readmission requiring PICU care and those with only a single PICU admission per annum. In this 2-year cohort, there were 239,157 index PICU patients of which 36,970 (15.5%) were readmitted and required PICU care during the 12 months following index admission. The total hospital cost for all index admissions and readmissions was $17.3 billion, of which 21.5% ($3.71 billion) were incurred during a readmission stay involving care in the PICU; of the 3,459,079 hospital days, 20.3% (702,200) were readmission days including those where PICU care was required. Of the readmitted patients, 11,703 (30.0%) received only PICU care, accounting for $662 million in costs and 110,215 PICU days. Although 43.6% of all costs were associated with patients who required readmission, these patients only accounted for 15.5% of the index patients and 28% of index hospitalization expenditures. More patients in the readmitted group had chronic complex conditions at index discharge compared with those not readmitted (83.9% vs 54.9%; p < 0.001). Compared with those discharged directly to home without home healthcare, patients discharged to a skilled nursing facility had 18% lower odds of readmission (odds ratio 0.82 [95% CI, 0.75–0.89]; p < 0.001) and those discharged home with home healthcare had 43% higher odds of readmission (odds ratio, 1.43 [95% CI, 1.36–1.51]; p < 0.001). Conclusions: Repeated admissions with PICU care resulted in significant direct medical costs and resource use for U.S. children’s hospitals.