Inpatient healthcare trends among adult cystic fibrosis patients in the U.S

Abstract

Background: Adult cystic fibrosis (CF) patients are an expanding cohort that is taken care of in a variety of hospital settings including adult centers located within pediatric institutions. This study compared costs and discharge rates among adult CF patient hospitalizations in terms of location of hospitalization.

Methods: The 2007 Nationwide Inpatient Sample was utilized to identify adult CF patient admission data on patients aged 18-44. Data were separated into pediatric and adult facilities based on percentage discharge rate for patients >18. Primary outcomes measures were length of stay (LOS) and total hospital charges. Secondary predictors were geographic, primary payer, and co-morbidity effects on LOS and total hospital charges.

Results: LOS was higher for adult CF patient admissions in pediatric facilities compared to adult facilities by a mean of 2.5 days. Mean total hospital charges were not significantly different. Adult hospitals in the Western U.S. had a mean total charge more than $50,000 greater than any region in the U.S. Self-pay patients had significantly fewer hospital days and charges across all hospital types. Adult facilities had 7% more CF patients discharged home with home healthcare use. Depressed CF patients had longer LOS by 1.5 days regardless of facility type.

Conclusions: LOS for adult CF inpatient admissions was significantly lower in adult facilities compared to pediatric facilities without a significant difference in hospital charges and is influenced by geographic hospital location. Depressed patients had longer lengths of stay regardless of facility type. Self-insured adult CF patients have a significant reduction in LOS and hospital charges when compared to all other payers regardless of hospital type.

Fig. 1

Length of stay by hospital type for adult CF patients. Adjusted length of stay in days for all admissions, and admissions >2 days for adult CF patients in pediatric, mixed and adult facilities. P values were significant at 0.02 for all admissions and 0.05 excluding short stay admissions <2 days.

Fig. 2

Hospital charges by hospital type for adult CF patients. Adjusted hospital charges in mean dollars for all admissions, and admissions >2 days for adult CF patients in pediatric, mixed, and adult facilities. P values were non-significant at 0.8 for all admissions and 0.4 excluding short stay admissions <2 days.