Home and Community Care Digest
Little People, Big Costs: Extended hospital stay is not cost-saving and does not improve clinical outcomes for preterm babies
Methods: 701 early discharge infants ("early babies") were matched to 701 infants who were discharged 2 to 7 days later ("late babies"). Financial outcomes consisted of in-hospital costs and cost of out-patient medical services following discharge (e.g. diagnostic tests, drugs and medical supplies used, as well as care personnel and room costs for additional days spent in a hospital). Clinical outcomes were based on coherence rank scores, comparing each of the 1,402 babies to all others in terms of physiological maturity (e.g. use of respirator/incubator, body temperature, incidences of apnea and bradycardia, weight, feeding method, and requirements for intravenous fluids). In addition to the level of physical maturity upon discharge, babies were also matched on the length of time required to reach physical maturity. Clinical outcomes of the matched pairs were regressed on matched pair differences in covariates.
Findings: Late babies were physiologically comparable to early babies and there was no difference in formal discharge requirements at the different hospitals. On average, total cost was higher in babies who stayed longer in the hospitals, by approximately $7,624.27 CDN (converted to 2001 Canadian dollars). However, subsequent differences in post-discharge costs (up to 180 days) were not significant, and averaged around $18.24 CDN. There were no significant differences in clinical outcomes between early and late babies; although late babies were ranked slightly, but not significantly, worse than early babies.
Conclusions: Once a preterm baby has achieved the physiological maturity for discharge, staying longer (for no other reason than to become more mature) is not cost-saving in the long term nor does it improve post-discharge clinical outcomes. Since the cost of extended hospital stay does not seem to provide significant benefits, one policy implication for improving neonatal care while reducing health care costs associated with preterm births is to establish uniform guidelines for determining when preterm babies should be discharged.
Silber JH, Lorch SA, Rosenbaum PR, Medoff-Cooper B, Bakewell-Sachs S, Millman A, Mi L, Even-Shoshan O, Escobar GJ. Time to send the preemie home? Additional maturity at discharge and subsequent health care cost and outcomes. Health Services Research, 2009.
Canadian Institute for Health Information (CIHI). Too Early, Too Small: A profile of small babies across Canada. Ottawa, ON: CIHI, 2009.
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