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Models for Determining Cost of Care and Length of Stay in Neonatal Intensive Care Units

Published online by Cambridge University Press:  10 March 2009

Babak Khoshnood
Affiliation:
Wyler Children's Hospital and University of Chicago
Kwang-Sun Lee
Affiliation:
Wyler Children's Hospital and University of Chicago
Maria Corpuz
Affiliation:
Wyler Children's Hospital and University of Chicago
Michael Koetting
Affiliation:
Wyler Children's Hospital and University of Chicago
Hui-Lung Hsieh
Affiliation:
Wyler Children's Hospital and University of Chicago
Beyong Ii Kim
Affiliation:
Wyler Children's Hospital and University of Chicago

Abstract

New models for determining the cost of care and length of stay in the neonatal intensive care unit (NICU) were developed using financial and clinical data from 588 admissions to our NICU. The model for determining costs explained 71% of the variability in total hospital costs. Models such as the ones developed in this study can be used to compare costs in different institutions, determine temporal trends in costs, and examine the financial impact of using new technologies. Such models can also be useful components of a rational prospective pricing system for the NICU.

Type
General Essays
Copyright
Copyright © Cambridge University Press 1996

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References

REFERENCES

1.Ales, K. L., Frayer, W.Hawks, G. et al. Development and validation of a multivariate predictor of mortality in very low birth weight. Journal of Clinical Epidemiology, 1988, 41, 1095–103.CrossRefGoogle ScholarPubMed
2.Berki, S. E., & Schneier, N. B.Frequency and cost of DRG outliers among newborns. Pediatrics, 1987, 79, 874–81.CrossRefGoogle ScholarPubMed
3.Boyle, M. H., Torrance, G. W., Sinclair, J. C., Horwood, S. P.Economic evaluation of neonatal intensive care of very-low-birth-weight infants. New England Journal of Medicine, 1983, 308, 1330–37.CrossRefGoogle ScholarPubMed
4.Budetti, P., Mcmanus, P., Barrand, N., & Neinen, L. A. U.S. Congress, Congress Office of Technology Assessment, The costs and effectiveness of neonatal intensive care. Washington, DC: Government Printing Office, 1981.Google Scholar
5.Doyle, L. W., Murton, L. J., & Kitchen, W. H.Increasing the survival of extremely- immature (24-to-28-weeks' gestation) infants—At what cost? Medical Journal of Australia, 1988, 150, 558–68.CrossRefGoogle Scholar
6.Duan, N.Smearing estimate: A nonparametric retransformation method. Journal of American Statistical Association, 1983, 78, 605–10.CrossRefGoogle Scholar
7.Gonnella, J. S., Hornbrook, M. C., & Louis, D. Z.Staging of disease: A case-mix measurement. Journal of the American Medical Association, 1984, 251, 637–44.CrossRefGoogle ScholarPubMed
8.Hernandez, J. A., Offutt, J., & Butterfield, L. J.The cost of care of the less-than-1000 gram infant. Clinics in Perinatology, 1986, 13, 461–76.CrossRefGoogle ScholarPubMed
9.Horn, S. D.Measuring severity of illness: Comparisons across institutions. American Journal of Public Health, 1983, 73, 2531.CrossRefGoogle ScholarPubMed
10.Horn, S. D., Bulkley, G., & Sharkey, P. D. et al. Interhospital differences in severity of illness. New England Journal of Medicine, 1985, 313, 2024.CrossRefGoogle ScholarPubMed
11.Horn, S. D., & Sharkey, P. D.Measuring severity of illness to predict patient resource use within the DRGs. Inquiry, 1983, 20, 314–21.Google ScholarPubMed
12.Horn, S. D., Sharkey, P. D., Chambers, A. F., Horn, R. A.Severity of illness within DRGs: Impact on prospective payment. American Journal of Public Health, 1985, 75, 1195–99.CrossRefGoogle ScholarPubMed
13.Imershein, A. W., Turner, C., Wells, J. G., & Pearman, A.Covering the costs of care in the neonatal intensive care units, Pediatrics, 1992, 89, 5661.CrossRefGoogle ScholarPubMed
14.Kaufman, S. L., & Shepard, D. S.Costs of neonatal intensive care by day of stay. Inquiry, 1982, 19, 167–78.Google ScholarPubMed
15.Leigh, J. P.Assessing the importance of an independent variable in multiple regression: Is stepwise unwise? Journal of Clinical Epidemiology, 1988, 41, 669–77.CrossRefGoogle ScholarPubMed
16.Lichtig, L. K., Knauf, R. A.Bartoletti, A. et al. Revising diagnosis-related groups for neonates. Pediatrics, 1989, 84, 4961.CrossRefGoogle ScholarPubMed
17.Mammel, M. C., Josten, L., Fuller, B. et al. Delivery in a tertiary care perinatal center reduces neonatal intensive care costs. Minnesota Medicine, 1986, 69, 504–06.Google Scholar
18.Manning, W. G., Newhouse, J. P., Duan, N. et al. Health insurance and the demand for medical care: Evidence from a randomized experiment. American Economic Review, 1987, 77, 251–77.Google ScholarPubMed
19.Marshall, P. B., Halls, H. J., Simon, L. J. et al. The cost of intensive and special care of the newborn. Medical Journal of Australia, 1989, 150, 568–74.CrossRefGoogle ScholarPubMed
20.Marten, K. G., & Vertees, J. C.The use of grade of membership analysis to evaluate and modify diagnostic-related groups. Medical Care, 1984, 22, 1067–82.Google Scholar
21.Neonatal intensive care for low birth weight infants: Cost and effectiveness. Washington, DC: U.S. Congress, Office of Technology Assessment, 1987.Google Scholar
22.Newns, B., Drummond, M. F., Durbin, G. M., & Culley, P.Costs and outcomes in a regional neonatal intensive care unit. Archives of Disease in Childhood, 1984, 59, 1064–67.CrossRefGoogle Scholar
23.Pharoah, P. O. D., Stevenson, R. C, Cooke, R. W. I, & Sandu, B.Costs and benefits of neonatal intensive care. Archives of Disease in Childhood, 1988, 63, 715–18.CrossRefGoogle ScholarPubMed
24.Phibbs, C. S., Phibbs, R. H.Pomerance, J. J., & Williams, R. L.Alternative to diagnosisrelated groups for newborn intensive care. Pediatrics, 1986, 78, 829–36.CrossRefGoogle ScholarPubMed
25.Phibbs, C. S., Williams, R. L., & Phibbs, R. H.Newborn risk factors and costs of neonatal intensive care. Pediatrics, 1981, 68, 313–21.CrossRefGoogle ScholarPubMed
26.Poland, R. L., Bollinger, R. O., Bedard, M. P., & Cohen, S. N.Analysis of the effects of applying federal DRG guidelines to a population of high-risk newborn infants. Pediatrics, 1985, 76, 104–09.CrossRefGoogle ScholarPubMed
27.Pomerance, J. J., Ukrainski, C. T., Ukra, T. et al. Cost of living for infants weighing 1,000 grams or less at birth. Pediatrics, 1978, 61, 908–10.CrossRefGoogle ScholarPubMed
28.Resnick, M. B., Ariet, M., Carter, R. L. et al. Prospective pricing system for tertiary neonatal intensive care. Pediatrics, 1986, 78, 820–28.CrossRefGoogle ScholarPubMed
29.Richardson, D. K., Gray, J. E., McCormick, M. et al. Score for neonatal acute physiology: A physiologic severity index for neonatal intensive care. Pediatrics, 1993, 91, 617–23.CrossRefGoogle ScholarPubMed
30.Ryan, S., Sics, A., Congdon, P.Cost of neonatal care. Archives of Disease in Childhood, 1988, 63, 303–06.CrossRefGoogle ScholarPubMed
31.Sandu, B., Stevenson, R. C., Cooke, R. W. I., & Pharoah, P. O. D.Cost of neonatal intensive care for very-low-birth-weight infants. Lancet, 1986, 1, 600–03.CrossRefGoogle Scholar
32.SAS/STAT user's guide, version 6, vol 1, 4th ed. Cary, NC: SAS Institute, 1989.Google Scholar
33.Schwartz, R. M., Michelman, T., Pezzullo, J., & Phibbs, C. S.Explaining resource consumption among non-normal neonates. Health Care Financing Review, 1991, 13(2), 1928.Google ScholarPubMed
34.Subramanian, C., Clark-Prakash, C., Dadina, Z. K. et al. Intensive care for high-risk infants in Calcutta. American Journal of Diseases in Children, 1986, 140, 885–88.CrossRefGoogle ScholarPubMed
35.Tarnow-Mordi, W., Ogston, S., Wilkinson, A. R. et al. Predicting death from initial disease severity in very low birth weight infants: A method for comparing the performance of neonatal units. British Medical Journal, 1990, 300, 1611–14.CrossRefGoogle ScholarPubMed
36.Walker, D. B., Feldman, A., Vohr, B. R., & Oh, W.Cost-benefit analysis of neonatal intensive care for infants weighing less than 1000 grams at birth. Pediatrics, 1984, 74, 2025.CrossRefGoogle Scholar
37.Walker, D. B., Vohr, B. R., & Oh, W.Economic analysis of regionalized neonatal care for very low-birth-weight infants in the state of Rhode Island. Pediatrics, 1985, 76, 6974.CrossRefGoogle ScholarPubMed
38.Wittink, D. R.The application of regression analysis. Needham Heights, MA: Allyn and Bacon, 1988, 6393.Google Scholar