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Financial, Resource Utilization and Mortality Impacts of Teaching Hospital Status on Pediatric Patients Admitted for Sepsis

Hsu, Benson S. MD, MBA, FAAP; Meyer, Benjamin D. MD; Lakhani, Saquib A. MD, FAAP

Pediatric Infectious Disease Journal: August 2017 - Volume 36 - Issue 8 - p 712–719
doi: 10.1097/INF.0000000000001526
Original Studies

Background: With the changing healthcare landscape in the United States, teaching hospitals face increasing pressure to provide medical education as well as cost–effective care. Our study investigated the financial, resource utilization and mortality impact of teaching hospital status on pediatric patients admitted with sepsis.

Methods: We conducted a retrospective, weighted statistical analysis of hospitalized children with the diagnosis of sepsis. The Agency for Healthcare Research and Quality 2009 Kids’ Inpatient Database provided the data for analysis. Diagnosis of sepsis and severity of illness levels were based on All Patient Refined Diagnosis-Related Groups of 720: Septicemia and Disseminated Infections. Teaching hospital status was based on presence of training programs. Statistical analysis was conducted using STATA 12.1 (Stata Corporation, College Station, TX).

Results: Weighted analysis revealed 17,461 patients with sepsis—9982 in teaching and 7479 in nonteaching hospitals. When comparing all patients, length of stay (8.2 vs. 4.8, P < 0.001), number of procedures received (2.03 vs. 0.87, P < 0.001), mortality (4.7% vs. 1.6%, P < 0.001), costs per day ($2326 vs. $1736, P < 0.001) and total costs ($20,428 vs. $7960, P < 0.001) were higher in teaching hospitals. Even when stratified by severity classes, length of stay, number of procedures received and total costs were higher in teaching hospitals with no difference in mortality.

Conclusions: Our study suggested that teaching hospitals provide pediatric inpatient care for sepsis at greater costs and resource utilization without a clear improvement in overall mortality rates in comparison with nonteaching hospitals.

From the Division of Critical Care Medicine, Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota.

Accepted for publication November 16, 2016.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Benson S. Hsu, MD, MBA, FAAP, Department of Pediatrics, Sanford School of Medicine, University of South Dakota, 1600 West 22nd Street, Sioux Falls, SD 57117. E-mail: Benson.Hsu@usd.edu.

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