Abstract: TH-PO916
Services Associated with Increased Cost of Hospitalization for Peritonitis in Pediatric Patients Receiving Chronic Peritoneal Dialysis
Session Information
- Dialysis: Infection
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 610 Dialysis: Infection
Authors
- Redpath, Allison C., University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
- Richardson, Troy, Children's Hospital Association, Overland Park, Kansas, United States
- Neu, Alicia, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Warady, Bradley A., The Children's Mercy Hospital, Kansas City, Missouri, United States
Group or Team Name
- SCOPE Collaborative
Background
Peritonitis is a leading cause of hospitalization in children on chronic peritoneal dialysis. The Standardizing Care to improve Outcomes in Pediatric ESRD (SCOPE) Collaborative has demonstrated a reduction in peritonitis rates and associated hospitalizations resulting in over $7million in cost-savings. Prior investigation has demonstrated that ICU stay and fungal peritonitis are associated with high-cost hospitalizations. The objective of this analysis is to describe service-line utilization associated with high-cost hospitalizations for peritonitis.
Methods
Peritonitis episodes reported by 24/29 SCOPE centers between 10/2011 and 9/2015 were linked with data in the Pediatric Health Information System (PHIS) database. Linkage was performed on the basis of sex, birth month and year, and date of peritonitis episode and hospitalization. Charges in PHIS were adjusted for cost-of-living differences and converted to costs. Detailed billing information was used to compare service-line utilization among the top 25 % of infection episodes by cost with bottom 75% and to compare fungal infection episodes to other types of infections.
Results
During the first 48 months of SCOPE, 266 peritonitis episodes were linked to 278 hospitalizations in PHIS. Detailed billing data was available for 246 hospitalizations and 238 peritonitis episodes. The proportions of hospitalization costs were similar between the top 25% of peritonitis episodes (N=66) and the lower 75% (N=180) for pharmacy (p=0.63), lab (p=0.30), imaging (p=0.85), supply (p=0.98), clinical (0.33) and other (p=0.18) service lines. Cost per case was significantly higher (p<0.001) for all service lines in the top 25% group. Compared with other types of infections (N=215), fungal peritonitis episodes (N=23) had elevated costs per episode (p<0.001) in lab, imaging, supply, room and board costs (including ICU costs) and costs associated with hemodialysis (HD).
Conclusion
The increase costs attributed to the top 25% of peritonitis hospitalizations can be attributed to all service lines. Increased hospitalization cost per case among fungal peritonitis infections is driven by increased room and board costs associated with prolonged length of stay, costs associated with HD, and lab costs.