Time to Send the Preemie Home? Additional Maturity at Discharge and Subsequent Health Care Costs and Outcomes

Authors

  • Jeffrey H. Silber,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 1029, Philadelphia, PA 19104,
    2. Departments of Pediatrics and Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA,
    3. Department of Health Care Systems, The Wharton School, The University of Pennsylvania, Philadelphia, PA,
    4. The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA,
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    • Address correspondence to Jeffrey H. Silber, M.D., Ph.D., Center for Outcomes Research, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 1029, Philadelphia, PA 19104; e-mail: silberj@wharton.upenn.edu. Jeffrey H. Silber, M.D., Ph.D., is with the Departments of Pediatrics and Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA. Jeffrey H. Silber, M.D., Ph.D., and Andrea Millman, B.A., are with the Department of Health Care Systems, The Wharton School, The University of Pennsylvania, Philadelphia, PA. Jeffrey H. Silber, M.D., Ph.D., Scott A. Lorch, M.D., M.S.C.E., and Orit Even-Shoshan, M.S., are with the The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA. Scott A. Lorch, M.D., M.S.C.E., Andrea Millman, B.A., Lanyu Mi, M.S., and Orit Even-Shoshan, M.S., are with the Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA. Scott A. Lorch, M.D., M.S.C.E., is with the Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA, and also with the Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA. Paul R. Rosenbaum, Ph.D., is with The Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA. Barbara Medoff-Cooper, Ph.D., R.N., is with The University of Pennsylvania School of Nursing, Philadelphia, PA. Barbara Medoff-Cooper, Ph.D., R.N., Susan Bakewell-Sachs, Ph.D., C.R.N.P., are with The Children's Hospital of Philadelphia. Philadelphia, PA. Susan Bakewell-Sachs, Ph.D., C.R.N.P., is with The College of New Jersey School of Nursing, Ewing, NJ. Gabriel J. Escobar, M.D., is with the Division of Research, Northern California Kaiser Permanente Medical Care Program, Oakland, CA.

  • Scott A. Lorch,

    1. The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA,
    2. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA,
    3. Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA,
    4. Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA,
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  • Paul R. Rosenbaum,

    1. Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA,
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  • Barbara Medoff-Cooper,

    1. University of Pennsylvania School of Nursing, Philadelphia, PA,
    2. The Children's Hospital of Philadelphia. Philadelphia, PA,
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  • Susan Bakewell-Sachs,

    1. The Children's Hospital of Philadelphia. Philadelphia, PA,
    2. The College of New Jersey School of Nursing, Ewing, NJ
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  • Andrea Millman,

    1. Department of Health Care Systems, The Wharton School, The University of Pennsylvania, Philadelphia, PA,
    2. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA,
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  • Lanyu Mi,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA,
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  • Orit Even-Shoshan,

    1. The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA,
    2. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA,
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  • Gabriel J. Escobar

    1. Division of Research, Northern California Kaiser Permanente Medical Care Program, Oakland, CA
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Abstract

Objective. To determine whether longer stays of premature infants allowing for increased physical maturity result in subsequent postdischarge cost savings that help counterbalance increased inpatient costs.

Data Sources. One thousand four hundred and two premature infants born in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2002.

Study Design/Methods. Using multivariate matching with a time-dependent propensity score we matched 701 “Early” babies to 701 “Late” babies (developmentally similar at the time the earlier baby was sent home but who were discharged on average 3 days later) and assessed subsequent costs and clinical outcomes.

Principal Findings. Late babies accrued inpatient costs after the Early baby was already home, yet costs after discharge through 6 months were virtually identical across groups, as were clinical outcomes. Overall, after the Early baby went home, the Late–Early cost difference was $5,016 (p<.0001). A sensitivity analysis suggests our conclusions would not easily be altered by failure to match on some unmeasured covariate.

Conclusions. In a large integrated health care system, if a baby is ready for discharge (as defined by the typical criteria), staying longer increased inpatient costs but did not reduce postdischarge costs nor improve postdischarge clinical outcomes.

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