TOP 45 - Principal Drivers and Interhospital Variation of Hospitalization Cost for Term Newborns Admitted to US Children’s Hospitals

Publication Number: 4748.TOP 45

Christhian A. Cano-Guerra, Boston Children's Hospital, Boston, MA, United States; Matt Hall, Children’s Hospital Association, Lenexa, KS, United States; Jay Berry, Boston Children's Hospital, Boston, MA, United States; John Zupancic, Harvard Medical School, Boston, MA, United States; Brian King, Harvard Medical School, Boston, MA, United States

Background: Newborns and infants account for 75% of pediatric hospitalizations. Hospitalizations for term newborns are rising, prompting concerns about resource overuse. Recent studies indicate that approximately 45% of patients admitted to Level IV Neonatal Intensive Care Units (NICUs) were at term, accounting for about 20% of hospital days. There is limited information on the characteristics of term newborns requiring the highest level of care and the reasons for transfer to these facilities.

Objective: This study aims to identify the most common reasons for the admission of term newborns to children's hospitals, determine the main drivers of healthcare costs, and assess the proportion of costs attributed to interinstitutional variability.

Design/Methods: Retrospective, cohort study of infants born at a gestational age (GA) ≥37 weeks, who were born, admitted, or transferred to children's hospitals in the United States that are affiliated with the Pediatric Health Information System (PHIS), from 2022 to 2024. The PHIS database contains clinical and resource utilization data of inpatient and outpatient services from nearly 50 children's hospitals. Subjects were identified by GA and birth weight, excluding those with GA <=37 weeks, >=45 weeks, >=6000 g, or those admitted after 7 days or from the emergency department (Figure 1).

Demographic information is presented in Table 1. The cohort included 236,634 subjects, predominantly male (52.4%) and non-Hispanic white (36.4%). Principal diagnosis, procedural codes, and cost information will be collected and analyzed in the upcoming months. The PHIS database includes a Cost Master Index with standardized unit costs derived from hospital billing information and hospital- and department-specific cost-to-charge ratios. Subjects will be classified into three groups based on the highest level of care required during their admission (NICU, non-NICU ICU, and non-ICU). Total costs and category costs (e.g., pharmaceutical, imaging) will be compared across levels of care. Resource utilization (by ranked categories) and the degree of interinstitutional variability (as measured by the intraclass correlation coefficient) will be assessed.

Multivariable models, clustered by hospital, will be used to identify demographic and clinical characteristics associated with higher utilization and costs.

Figure 1. Flow diagram demonstrating study cohort building


Table 1. Demographics and clinical characteristics of the cohort