Fellow Baylor College of Medicine Houston, Texas, United States
Background: Overuse is estimated to account for billions of dollars of wasteful spending each year. Echocardiography (echo) is a costly and frequently used imaging test among preterm infants. Understanding inter-hospital variability in utilization can identify opportunities for reducing overuse.
Objective: Describe inter-hospital variation in echo use among very preterm infants admitted to children’s hospital-associated neonatal intensive care units (NICUs). Assess the association between early-echo use and the number of echo days per patient during their hospital stay.
Design/Methods: Retrospective cohort study of very preterm (<32 weeks gestation) infants admitted within 1 day of life to US Children’s Hospitals using the PHIS Database (2012-2019). Any echo (at least once), early echo (age <4 days), number of days with an echo charge per patient and the mean cost of echos per patient were compared across hospitals in the total cohort, and a subgroup of infants <27 weeks. Costs were estimated from inpatient charges using hospital and department specific cost-to-charge ratios. Patient demographics and a length-of-stay based relative weight index were used to adjust for severity of illness. Inter-hospital variability was estimated using adjusted hospital echo rates, observed/expected hospital outliers in echo use, and the coefficient of variation for each measure of utilization.
Results: 31,496 infants from 39 children’s hospitals met inclusion criteria (Table 1). Unadjusted and adjusted utilization rates are summarized in Table 2. The greatest inter-hospital variation was seen in the proportion of infants receiving an early echo. Among the entire cohort, 12 hospitals (30%) were high utilizers of early echocardiography, defined by a risk-adjusted proportion of infants above the 95% confidence interval (Figure 1). Hospitals with a higher adjusted proportion of infants receiving an early echo were more likely to have a higher average number of echo days per patient (p = 0.001) (Figure 2). Conclusion(s): Significant inter-hospital variation exists in echocardiography utilization across US children’s hospitals after adjusting for patient-level demographics and illness severity. The greatest variation is seen in early echo use (<4 days of life), and hospitals with higher proportions of infants receiving early echos are more likely to perform more echos per patient during the entire hospital stay. This variation highlights a potential opportunity for targeted reduction in unnecessary use of a costly imaging modality.
Authors/Institutions: Brian King, Baylor College of Medicine, Houston, Texas, United States; Joseph L. Hagan, Baylor College of Medicine, Houston, Texas, United States; Troy Richardson, Children's Hospital Association, Lenexa, Kansas, United States; Jonathan L. Slaughter, Nationwide Children's Hospital/The Ohio State University, Columbus, Ohio, United States
