J. K. Chica1,2, M. A. Bartz-Kurycki1,2, E. B. Avritscher3, K. Tsao1,2, M. T. Austin1,2 1McGovern Medical School at UTHealth,Department Of Pediatric Surgery,Houston, TX, USA 2Children’s Memorial Hermann Hospital,Department Of Pediatric Surgery,Houston, TX, USA 3McGovern Medical School at UTHealth,Department Of Pediatrics,Houston, TX, USA
Introduction: Infants who are discharged from the neonatal intensive care unit (NICU) are known to be at a higher risk of having an unplanned healthcare visit given the complex care that they often require. Many of these infants have chronic medical conditions that also place them at a higher risk for complications. These unplanned healthcare visits not only have a clinical impact on the infant, but also result in substantial additional healthcare expenditures. We had previously studied factors associated with increased post-discharge healthcare utilization for NICU infants discharged within our healthcare system. In this study, we aimed to estimate the health system costs of unplanned hospital visits in NICU infants up to 90 days post-discharge.
Methods: A retrospective review had previously been performed of all infants discharged from the NICU between Jan 1, 2017 and March 31, 2017. We identified the subset of infants who had any unplanned hospital visit (readmissions and emergency department (ED) visits) within 90 days of NICU discharge. Patients with NICU stay < 3 days were excluded. Those who had an unplanned hospital visit outside of our healthcare system were not included in our cost analysis as these costs were not available. Costs were estimated in 2017 US dollars based on the health system perspective. Hospital costs for the unplanned visits were obtained from the institutional accounting system of our hospital system.
Results: Of the 414 infants discharged from the NICU during the study period, 65 patients (16%) had an unplanned hospital visit within 90 days of discharge. The majority were male (62%), Medicaid insured (71%), with a mean gestational age of 33 weeks at birth. Thirty-five patients had an ED visit, 29 were readmitted to the hospital, and 1 patient had both an ED visit and hospital readmission on separate occasions. The total costs for the 65 infants with unplanned hospital visits were estimated to be $785,804 with a mean of $12,089 (95%CI $2,099-$22,079) per patient. Hospital readmissions accounted for 98% ($768,718) of the total costs and ED visits for 2% ($17,086). The mean cost per readmission and ED visit was $25,624 (95%CI $4,390-$46,858) and $475 (95%CI $233-$716) respectively.
Conclusion: Approximately half of the patients who had an unplanned hospital visit within 90 days after discharge from the NICU were readmitted to the hospital and hospital readmission accounted for 98% of total costs. In a 3 month period, readmissions of recent NICU graduates cost the healthcare system nearly $1 million. In future work, we plan to develop and test a comprehensive transition to home program for parents of NICU graduates that aims to improve patient outcomes and decrease healthcare resource utilization following discharge.