The cost of a pediatric neurocritical care program for traumatic brain injury: A retrospective cohort study

Steven W. Howard, Zidong Zhang, Paula Buchanan, Stephanie L. Bernell, Christine Williams, Lindsey Pearson, Michael Huetsch, Jeff Gill, Jose A. Pineda

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Abstract

Background: Inpatient care for children with severe traumatic brain injury (sTBI) is expensive, with inpatient charges averaging over $70,000 per case (Hospital Inpatient, Children Only, National Statistics. Diagnoses- clinical classification software (CCS) principal diagnosis category 85 coma, stupor, and brain damage, and 233 intracranial injury. Diagnoses by Aggregate charges [ https://hcupnet.ahrq.gov/#setup ]). This ranks sTBI in the top quartile of pediatric conditions with the greatest inpatient costs (Hospital Inpatient, Children Only, National Statistics. Diagnoses- clinical classification software (CCS) principal diagnosis category 85 coma, stupor, and brain damage, and 233 intracranial injury. Diagnoses by Aggregate charges [ https://hcupnet.ahrq.gov/#setup ]). The Brain Trauma Foundation developed sTBI intensive care guidelines in 2003, with revisions in 2012 (Kochanek, Carney, et. al. PCCM 3:S1-S2, 2012). These guidelines have been widely disseminated, and are associated with improved health outcomes (Pineda, Leonard. et. al. LN 12:45-52, 2013), yet research on the cost of associated hospital care is limited. The objective of this study was to assess the costs of providing hospital care to sTBI patients through a guideline-based Pediatric Neurocritical Care Program (PNCP) implemented at St. Louis Children's Hospital, a pediatric academic medical center in the Midwest United States. Methods: This is a retrospective cohort study. We used multi-level regression to estimate pre-/post-implementation effects of the PNCP program on inflation adjusted total cost of in-hospital sTBI care. The study population included 58 pediatric patient discharges in the pre-PNCP implementation group (July 15, 1999 - September 17, 2005), and 59 post-implementation patient discharges (September 18, 2005 - January 15, 2012). Results: Implementation of the PNCP was associated with a non-significant difference in the cost of care between the pre- and post-implementation periods (eβ = 1.028, p = 0.687). Conclusions: Implementation of the PNCP to support delivery of guideline-based care for children with sTBI did not change the total per-patient cost of in-hospital care. A key strength of this study was its use of hospital cost data rather than charges. Future research should consider the longitudinal post-hospitalization costs of this approach to sTBI care.

Original languageEnglish
Article number20
JournalBMC health services research
Volume18
Issue number1
DOIs
StatePublished - Jan 12 2018

Keywords

  • Child health
  • Cost of care
  • Guidelines
  • Neurocritical care
  • Traumatic brain injury

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    Howard, S. W., Zhang, Z., Buchanan, P., Bernell, S. L., Williams, C., Pearson, L., Huetsch, M., Gill, J., & Pineda, J. A. (2018). The cost of a pediatric neurocritical care program for traumatic brain injury: A retrospective cohort study. BMC health services research, 18(1), [20]. https://doi.org/10.1186/s12913-017-2768-0