Sara Pasquali, M.D., M.H.S., is an associate professor in the Division of Pediatric Cardiology and was the lead author of the study.
Costs vary widely for care of children with congenital heart defects
issue 21 | Spring-Summer 2014
The cost of care for children with congenital heart disease undergoing surgical repair varied as much as nine times across a large group of U.S. children's hospitals, according to new research published in Pediatrics.
"Before we conducted this study, there was limited information on the costs associated with caring for these children, even though this is one of the most common and expensive conditions treated across children's hospitals," says lead author Sara K. Pasquali, M.D., M.H.S., associate professor of pediatrics at the University of Michigan Medical School and C.S. Mott Children's Hospital Congenital Heart Center.
Pasquali and her co-authors studied 12,718 patients from 27 U.S. children's hospitals and found wide variation between hospitals in costs associated with congenital heart surgery for nearly every operation examined. These differences were apparent even after accounting for differences in patient characteristics and for regional differences in cost.
VOLUMES, COSTS, OUTCOMES LINKED
The investigators also found that hospitals with higher case volumes had significantly lower costs for the most complex operations.
In the study, the highest cost hospitals had higher rates of post-operative complications, and their patients tended to stay in the hospital for a longer period of time after surgery. For example, the study found that hospitals with the highest costs after the Norwood operation had double the rate of major complications compared with hospitals with the lowest costs. In addition, the higher cost hospitals had an average length of stay after the Norwood operation nearly twice as long as the low-cost hospitals.
STANDARDIZING CARE COULD HELP
Initiatives aimed at reducing length of stay and complication rates have the potential to both improve quality and also lower costs. A recent study conducted by the U-M Congenital Heart Center showed that standardizing care for children with chylothorax after surgery led to earlier diagnosis, significantly reduced time on the ventilator and decreased length of stay.
"The cost variations we found in this study suggest there is ample room for improvement and also suggest a link between high-quality care and lower cost," says Pasquali.