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Health Serv Res. 2009 Apr;44(2 Pt 1):444-63. doi: 10.1111/j.1475-6773.2008.00938.x. Epub 2008 Dec 31.

Time to send the preemie home? Additional maturity at discharge and subsequent health care costs and outcomes.

Author information

1
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. silberj@wharton.upenn.edu

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.

PMID:
19207592
PMCID:
PMC2677048
DOI:
10.1111/j.1475-6773.2008.00938.x
[Indexed for MEDLINE]
Free PMC Article
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