Abstract 16297: High Quality Care is Associated With Lower Costs for Congenital Heart Surgery Across US Children’s Hospitals
Introduction: There is currently a focus on both optimizing healthcare quality and reducing costs, or high “value” care. However, the care of children undergoing heart surgery requires significant investment of resources, and it is unclear whether it is possible to deliver high quality care, but also at a low cost. We evaluated the quality-cost relationship across a large multi-center cohort.
Methods: Clinical data from The Society of Thoracic Surgeons Database were linked to cost data from the Pediatric Health Information Systems Database for children 0-18 yrs undergoing heart surgery at hospitals participating in both datasets (2006-10). Hospital costs were modeled using Bayesian hierarchical methods, adjusting for procedural case mix [using Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STAT) methods] and important patient characteristics. Adjusted mortality rates were compared across hospital cost tertiles. Complications and length of stay (LOS) were also examined.
Results: Overall, 30,670 patients (27 hospitals) were included. Median adjusted cost/case was $82,360 and varied 5-fold across hospitals. Hospitals in the lowest cost tertile tended to be larger volume centers treating higher complexity patients (26.5% vs. 22.8% in STAT category 4/5 in low vs. high cost centers, p<0.0001). Low cost hospitals had significantly lower adjusted mortality rates compared with the middle and high cost tertiles (2.5% vs. 3.8% and 3.5% respectively, p<0.0001, Figure). Lower cost hospitals also had shorter LOS and fewer major complications.
Conclusions: In this analysis, the lowest cost hospitals also appeared to deliver the highest quality care for children undergoing heart surgery, despite treating a more complex patient population. These results suggest that initiatives aiming to improve outcomes, whether through quality improvement or regionalizing care, may also have the potential to lower costs.
Author Disclosures: S.K. Pasquali: None. J.P. Jacobs: None. E.L. Bove: None. J.W. Gaynor: None. X. He: None. M.G. Gaies: None. J.C. Hirsch-Romano: None. J.E. Mayer: None. E.D. Peterson: None. N.M. Pinto: None. S.S. Shah: None. M. Hall: None. M.L. Jacobs: None.
- © 2014 by American Heart Association, Inc.