Showing posts with label advocacy. Show all posts
Showing posts with label advocacy. Show all posts

Wednesday, October 14, 2015

A Costly, Complex Year: Examining Healthcare Cost And End of Life Care

By: Joann Schulte  DO, MPH; Editorial Board Member 

      Almost two-thirds of bankruptcy filings have a medical cause and 14.6% of those interviewed for bankruptcy in 2007 had anill child1with a complex medical condition. An estimated 2.8 to 3.3 million individuals with vast medical bills file for bankruptcy each year2.  If the percentage of filers with children has remained constant, it means between 408,800 and 481,800 people seeking bankruptcy protection each year have children with complex illnesses severe enough to prompt the filings.
      Work published this early relased recently in Pediatrics from  (doi: 10.1542/peds.2015-0260) will help provide needed information for children’s medical care and costs in the last year of life.  A group of researchers from Boston and Philadelphia used data from the forty-one free-standing children’s hospitals to describe illness and costs for such children.  The hospitals submitted data to the Pediatric Health Information System database, an administrative database that contains inpatient utilization and cost data. Children are assigned a unique identifier to track them across multiple admissions. The researchers used the data to characterize the admissions and costs incurred among a cohort of 1,252 children who were admitted and died in calendar year 2012.  Infants less than a year of age were excluded to ensure a complete one-year review.
      Those children had complex medical conditions in nine organ systems:  cardiovascular, congenital/genetic, gastrointestinal, hematologic/immunologic, malignancy, metabolic, neuromuscular, renal and respiratory. The authors converted charges to costs, using an existing ratio for each hospital and they adjusted for inflation by using the Consumer Price Index.
The authors found that the children in their last year of life had medians of two admissions, twenty-seven hospital days and $142,562 in hospital costs. Total hospital costs were $392 million, of which 58% occurred in the final admission for these children to the hospital($228 million).
      In a multivariate analysis, children diagnosed with hematological/immunologic conditions have the greatest impact on hospital resource use.  Compared to children with other complex conditions, children with hematologic/immunologic conditions spend 45 more days in the hospital and accumulated $326,844 more in hospital costs.  The vast majority of children (987, 79%) spent time in the intensive care unit and most were mechanically ventilated (946, 76 %) during their last admissions.
      These 1,252 children had an unhappy outcome, but information about their hospitalizations is an important step in painting a detailed picture about terminal pediatric illnesses.  Having such information may help economists and pediatric providers both provide needed care and figure out how to do so without bankrupting families.  


1. Himmelstein DU, Thorne D, Warren E, Woolhandler S.  Medical bankruptcy in the United States, 2007:  Results of a national study.  American Journal of Medicine  2009; 122 (8):741-746.

2. Himmelstein DU, Warren E, Thorne D, Woolhandler S.  Market Watch: Illness and injury as contributors to bankruptcy.  http://content.healthaffairs

Tuesday, July 21, 2015

Choosing Wisely: New Suggestions for Adding Value and Decreasing Costs in Caring for Newborns

By: Lewis First, MD, MS; Editor-in-Chief  
German Tenorio

   The Choosing Wisely campaign, started by the ABIM Foundation, has spread to include all medical fields—offering suggestions for ways to reduce unnecessary tests based on evidence to date. The American Academy of Pediatrics has endorsed ten recommendations for “Choosing Wisely” that can be found at the following link While these recommendations deal with infant, toddler and childhood pediatric conditions, up until now we have not had recommendations for ways to add value and reduce costs in newborns. Fortunately this week, Ho et al. (doi: 10.1542/peds.2015-0737) offer five tests and treatments that should not be automatically considered for newborns based on an expert consensus panel. 
      The five areas include (1) avoidance of anti-reflux medications for symptomatic gastroesophageal reflux disease or for apnea and desaturations in preterm infants; (2) avoidance of antibiotics beyond 48 hours when initial cultures are negative and infants remain asymptomatic (30 avoidance of pneumograms for apnea of prematurity; (4) avoidance of routine daily chest x-rays without an indication in intubated infants; and (5) avoidance of routine term or discharge MRIs in previously preterm infants.   
     This special article reviews the rationale leading to these decisions and is a welcome contribution to maintaining high quality in newborns while reducing cost—which can only enhance the value of the care we provide to this population.  Choose wisely and read this article and hopefully implement these five suggestions if you haven’t already.

Related Links

Monday, June 1, 2015

The Effect of State-level Alcohol Policies on Youth Drinking Behaviors

By: Lewis First, MD, MS; Editor-in-Chief       
       States have different policies when it comes to preventing access to drink alcohol—but do these policies result in different prevalence statistics of alcohol use in teens?  Xuan et al. (doi: 10.1542/peds.2015-0537) looked at strength of alcohol policies and the responses of high school students who participated in the national Youth Risk Behavior Survey from 1999 through 2011. 
       It is important to read that states with the stronger policies affecting access to alcohol for whole populations rather than just youth are the ones that have the lowest rate of youth drinking.  So how strict are your state’s alcohol policies—and do you think they do make a difference in reducing youth alcohol use?  Share your thoughts with us by responding to this blog, sending an e-letter, or posting your thoughts on our Facebook or Twitter sites.

Related Links: 

Tuesday, May 5, 2015

Good Things Come to Those Who Wait—and Finally the Annual Summary of Vital Statistics Has Arrived

By: Lewis First, MD, MS; Editor-in-Chief    

          Collecting vital statistics and analyzing them is easier said than done, but when they are finally compiled, released, and available for analysis we can learn a lot. Such has been the case with our journal publishing an annual summary of vital statistics provided by National Center for Health Statistics within the Centers for Disease Control and analyzed by Osterman et al. (doi:10.1542/peds.2015-0434) who compile birth and death certificate data from 2012-2013as well as other epidemiologic information that helps us understand contributors to infant, child, and adolescent birth and death rates.   There is no better way to look at the health of the population we serve than through large national datasets, and this article is rich in information and in turn trends and patterns from which we can focus improvements in health prevention.  While you might think reading through vital statistics is not exciting, this study will prove you wrong—with lots of interesting findings well worth reading and thinking about in terms of ways you can adjust your own office-based strategies for improving health outcomes in your patients.  It’s vital reading—so give this special article some attention.
          We also want to take this opportunity to thank Dr. Bernard Guyer, Zanvyl Krieger Professor of Children’s Health, Emeritus, at Johns Hopkins Bloomberg School of Public Health who has served as co-author and editor of these annual summaries for the past 20 years.  This represents his last summary and he has posted a note to readers at the start of this article that we also want to share with our blog readers.  Dr. Guyer’s comments follow:

This will be my last “Annual Summary.” After 20 years as a coauthor, organizer and editor (1995-2014), it’s time to pass the baton to the next public health pediatrician on the team.  Lest the casual reader think that I have overstayed my welcome, I remind you that Myron Wegman, authored this article for 45 years, from 1950 to 1994. 

Our greatest accomplishment over this period has been to make the writing of the paper a collaboration between the academic and professional communities- namely, colleagues at the CDC National Center for Health Statistics who now coauthor the paper and assure its accuracy.  Thus, many new data-sets, features and analyses were added.

I am gratified that the paper is widely read and quoted every year, and that the published data are far more accessible to the pediatricians than are government publications. Many thanks to the American Academy of Pediatrics and to editors, Jerry Lucey and Lewis First, for their support.

I believe that future authors will make even greater strides by using new technologies- electronic birth and death certificate data and rapid communication of events to state agencies- to create more timely birth and death indicators to inform policy-makers and practitioners.  Pediatricians need to support such developments, continue to use the information provided, and make their support for excellent national statistics known to policy-makers and agency leaders.  

Thanks Dr. Guyer for making the annual summaries of vital statistics a much valued and sought-after contribution to Pediatrics.