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Inpatient Childhood Asthma Treatment
Relationship of Hospital Characteristics to Length of Stay and Cost: Analyses of New York State Discharge Data, 1995
Zhihuan J. Huang, PhD;
Bonnie J. LaFleur, PhD;
James M. Chamberlain, MD;
Mark F. Guagliardo, PhD;
Jill G. Joseph, MD, PhD
Arch Pediatr Adolesc Med. 2002;156:67-72.
Background There is increasing pressure to optimize asthma treatment efficiency.
It is possible that hospital characteristics influence such efficiency.
Objective To examine the association of selected hospital characteristics with
cost and length of stay (LOS) among pediatric patients with asthma after adjusting
for patient characteristics.
Design Secondary analysis of 1995 hospital discharge data in the state of New
York.
Subjects Nineteen thousand six hundred eighty-eight patients aged 1 to 17 years
with asthma discharged from 206 acute care hospitals in New York in 1995.
Main Outcome Measures Length of stay and hospital cost.
Analysis Hospitals were described with respect to teaching status and ownership.
The differences in the distribution of children within each hospital type
were assessed by  2 tests. In multivariate analyses, hierarchical
models were constructed to analyze cost and LOS, adjusting for both hospital-
and patient-level covariance.
Results Asthma severity did not meaningfully differ by hospital ownership and
teaching status. Public and teaching hospitals had more minority and Medicaid
patients. After adjusting for patient- and hospital-level covariates and for
the hierarchical nature of the data, there were no statistically significant
differences between public and private hospitals in mean cost or LOS. Adjusted
mean LOS in teaching hospitals was not significantly shorter, while costs
were significantly but not meaningfully greater ($2459 vs $2271; P<.001).
Conclusion Hospitals providing medical education to pediatricians and safety net
care do so without increasing LOS or cost of care for pediatric asthma.
From the Center for Health Services and Community Research, Children's
National Medical Center (Drs Huang, LaFleur, Guagliardo, and Joseph), The
George Washington University School of Medicine and Health Sciences (Drs LaFleur,
Guagliardo, and Joseph), and the Department of Emergency Medicine (Dr Chamberlain),
Washington, DC.
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