AHRQ Data Help Boston Children's Hospital Determine Quality, Cost, and Use of Cardiac Services
Data from the HCUP-Kids' Inpatient Database (KID) is the cornerstone of several research projects at Children's Hospital Boston. The projects address quality, cost, and the utilization of cardiac services for congenital heart disease in children.
Jean Connor, DNSc, RN, CPNP, Co-Director, Cardiology and Clinical Research and Regulatory Group at Children's, has led investigations of resource use and efficiency of care under the mentorship of Drs. Kimberlee Gauvreau and Kathy Jenkins. Connor first became familiar with KID data when she used it during her PhD work at Columbia University in 1997. At Children's, she has built on research that began by looking at costs for children undergoing heart surgery.
Ultimately, Connor concluded that states varied considerably in a risk-adjusted measure of both quality and resource use for congenital heart surgery procedures. She says, "This novel approach may be the first step in identifying optimal charge structures for delivering care. Identification of optimum charge structures may be used by health care providers, institutions, payers, and policy makers when formulating interventions and policies to allocate resources for congenital heart surgery."
Originally, Connor and her colleagues used KID 2000 data to examine factors associated with increased resource utilization for children with congenital heart disease. The results of that analysis showed a wide range of charges in the 27 states examined, which at first appeared to be caused by demographic and clinical factors.
To address those variables, the second project adjusted the analysis to consider the complexity of disease, the cost of living in the region, insurance, and HMO penetration. The team examined costs associated with children's heart surgery, again from a state perspective.
Overall results still showed variability among states in cost. The group found that surgery and treatment for children's congenital heart disease was more expensive in states having one or more children's hospitals. This state-level finding might suggest that higher quality care costs more; thus, both quality and cost of care should perhaps be viewed in a composite manner.
"Our next steps will be to examine variation in costs by institution," Connor notes. Using both KID 2000 and 2003 data, her group will examine standardized cost/charge ratios and mortality ratio measures to examine the relationship between cost and quality. Examinations of quality, resource use, and efficiency for children undergoing congenital heart surgery are important indicators of cardiovascular program performance.
One of the largest pediatric medical centers in the United States, Children's Hospital Boston is a 342-bed comprehensive center for pediatric health care. Over 450,000 patients receive care annually at Children's, which is the primary pediatric teaching hospital of Harvard Medical School. It is also home to the world's largest pediatric research facility, with a staff of 1,200 scientists and staff.
The KID is one in a family of databases and software tools developed as part of AHRQ's Healthcare Cost and Utilization Project (HCUP). The KID is the only all-payer inpatient care database for children in the United States. It contains data from two to three million hospital discharges for children. The most recent release, the 2003 KID, contains data drawn from 36 state inpatient databases on patients 20 years of age and younger. For more information, visit http://www.hcup-us.ahrq.gov/kidoverview.jsp.
Connor, JA, Gauvreau, K, and Jenkins, KJ. Factors associated with increased resource utilization for congenital heart disease. Pediatrics Sept. 2005: 116(3):689-695.