Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 1;5(6):e2218348.
doi: 10.1001/jamanetworkopen.2022.18348.

Association of Children's Hospital Status With Value for Common Surgical Conditions

Mehul V Raval  1   2 , Audra J Reiter  1   2 , Ian M McCarthy  3
Affiliations

Association of Children's Hospital Status With Value for Common Surgical Conditions

Mehul V Raval et al. JAMA Netw Open. .

Abstract

Importance: Although children's hospitals (CH) provide a substantial proportion of highly specialized pediatric care in the United States, the value of CH compared with non-children's hospitals (NCH) for routine surgical procedures is unknown.

Objective: To examine the value of CH for routine surgical procedures by assessing clinical outcomes and payment data.

Design, setting, and participants: This retrospective cohort study examined pediatric patients undergoing 1 of 13 commonly performed surgical procedures between 2010 and 2015 with 90-day follow-up using administrative data from the Health Care Cost Institute. Data analysis was conducted from July 2019 to December 2021.

Exposures: The primary exposure was tier of CH status, defined using self-reported pediatric services, affiliation with pediatric focused programs, and validated based on proportion of pediatric admissions.

Main outcomes and measures: Payments for common surgical procedures from private insurers and overall complication and readmission rates at 30, 60, and 90 days.

Results: There were 368 220 pediatric patients who underwent one of the surgical procedures of interest; 220 899 (60.0%) of the patients were male; 118 977 (32.3%) had their procedure at freestanding CH (CH-A), 75 256 (20.4%) at CH attached to an adult hospital (CH-B), and 173 987 (47.3%) at NCH. The mean (SD) payment for all procedures at CH-A was $6533.56 ($6399.97), $5847.50 ($4947.47) at CH-B, and $5034.25 ($4787.07) at NCH. The mean (SD) overall complication rate was 0.004 (0.06) at CH-A, 0.01 (0.07) at CH-B, and 0.003 (0.06) at NCH. Readmission rates at 30, 60, and 90 days were similar across all hospital types. After adjusting for zip code, year, surgery, surgery setting, and observable patient, hospital, and county characteristics, the estimated payments for inpatient common procedures were 39% higher at CH-A than at NCH. Payments for outpatient common procedures were 34% higher at CH-A than at NCH.

Conclusions and relevance: In this cohort study, children who underwent common surgical procedures had equivalent clinical outcomes at CH and NCH but the procedures were associated with higher payments and, thus, overall lower value care. To ensure delivery of optimal value to patients and payers, more research is needed to evaluate mechanisms to ensure access, decrease costs, and improve value at both CH and NCH.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Raval reported receiving personal fees from Abbott Nutrition and Finley Law outside the submitted work. Dr Reiter reported receiving personal fees from Intuitive Surgical outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flowchart
HCCI indicates Health Care Cost Institute; NPI, National Provider Identifier.
Figure 2.
Figure 2.. Mean Payments From Commercial Insurers Using Health Care Cost Institute Data for Common Procedures at Children’s Hospitals (CH) and Non–Children’s Hospitals (NCH)
CH-A indicates CH tier A (freestanding CH); and CH-B, CH tier B (CH attached to adult hospital).
See this image and copyright information in PMC

References

    1. All Children Need Children’s Hospitals . 2nd ed. National Association of Children’s Hospitals and Related Institutions; 2007. Accessed October 21, 2021. https://www.upstate.edu/gch/pdf/academics/allchildren.pdf
    1. Allen SW, Gauvreau K, Bloom BT, Jenkins KJ. Evidence-based referral results in significantly reduced mortality after congenital heart surgery. Pediatrics. 2003;112(1 I):24-28. doi:10.1542/peds.112.1.24 - DOI - PubMed
    1. Chang RKR, Klitzner TSS. Can regionalization decrease the number of deaths for children who undergo cardiac surgery? a theoretical analysis. Pediatrics. 2002;109(2):173-181. doi:10.1542/peds.109.2.173 - DOI - PubMed
    1. Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477-2481. doi:10.1056/NEJMP1011024 - DOI - PubMed
    1. Gaul G. Growing size and wealth of children’s hospitals fueling questions about spending. Kaiser Health News. Published 2011. Accessed October 21, 2021. https://khn.org/news/childrens-hospitals-part-one/

Publication types