Does place matter?: Institution type and resource utilization for hospitalized children

Michelle A Lopez, The University of Texas School of Public Health


Background: Hospitalized children receive care in a variety of settings. While there is ongoing research describing care in children's hospitals, the differences in resource utilization across hospitals types have not been well described. Objective: The aims of our study were to describe where children receive care for common inpatient diagnoses and to examine the associated LOS and costs across hospital types that care for children. Design/Methods: This was a cross sectional study of the 2012 Healthcare Cost and Utilization Project Kids' Inpatient Database. We examined pediatric hospitalizations (0-18 years) with common acute care conditions. The main independent variable was hospital type: Children's Hospitals (CH), Non-children's teaching hospitals (NCT), Non-children's non-teaching hospitals (NCNT). Primary outcomes were mean length of stay (LOS) in days and mean cost per discharge. Multivariate linear regression was used to assess differences in costs controlling for age, race, gender, payer, APR-DRG severity, income quartile, hospital bed size, day of admission, hospital region, number of complex conditions, number of diagnoses, and number of procedures. Results were reported as adjusted differences in LOS and costs with 95% confidence intervals (CI). P values <0.05 were deemed statistically significant. Results: In 2012, there were 388,803 pediatric discharges with a primary diagnosis of pneumonia, asthma, acute bronchitis, appendicitis, FEN disorders and SSTI. NCNT hospitals were the most frequent discharging hospital type (43.9%). After adjusting for patient and hospital level factors, CH hospitals mean LOS remained 0.22 days higher (95% CI: 0.10, 0.34) and mean cost was $2,824 greater than NCNT hospitals (95% CI: $2533, $3116) [Table 4]. Mean LOS and costs were not significantly higher at NCT compared to NCNT hospitals in adjusted analysis. The adjusted mean cost of hospitalizations in Black patients was $317 higher than White patients (95% CI: 134, 500). Conclusions: Care in children’s hospitals is not necessarily reflective of care across all hospital types and a high volume of care for common conditions and for underserved populations is provided outside of children’s hospitals. Future pediatric health services studies and public policies affecting the pediatric inpatient community should remain inconclusive of all locations where children receive care.

Subject Area

Management|Health care management

Recommended Citation

Lopez, Michelle A, "Does place matter?: Institution type and resource utilization for hospitalized children" (2015). Texas Medical Center Dissertations (via ProQuest). AAI10109660.