Impact of Payer Status on Hospitalization Outcomes in Pediatric Diabetic Ketoacidosis

Abstract

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication seen in patients suffering from type I diabetes (T1D) with a cost burden of over $5 billion in the U.S. annually. Often, children are first diagnosed with T1D when they present with DKA. Our study examines the impact of payer type on pediatric DKA. We hypothesize that Medicaid payer type negatively impacts costs and care outcomes in pediatric patients with DKA as compared to private payers.

Methods: We utilized the Agency for Healthcare Research and Quality (AHRQ) 2012 Kids' Inpatient Database (KID) for analysis. Our inclusion criterion included All Patient Refined Diagnosis Related Groups (APR-DRG) coding for T1D DKA admissions with a uniform severity and an identifiable payer of Medicaid or private insurance.

Results: 27,241 weighted and severity-adjusted discharges met criterion (51.6 percent Medicaid payers, 48.4 percent private). Comparing Medicaid vs. private payer status, we found: length of stay (2.24 days vs. 2.09), number of procedures received (0.13 vs. 0.12), and total charges ($16,449 vs. $16,107). Limiting analysis to a crude measure of bottom quartile income showed: length of stay (2.26 days vs. 2.14), number of procedures received (0.12 vs. 0.12), and total charges ($15,393 vs. $14,063).

Conclusions: Children admitted in DKA and covered by Medicaid had longer hospitalizations, more procedures performed, and higher total costs of care. Even after controlling for socioeconomic status, similar effects persisted. Further evaluations are warranted to reveal the causative factors behind these correlative findings which suggest DKA patients receive different care depending on their payer status.