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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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