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485 Hospital Charges for Pediatric Heart Transplant Hospitalizations in the United States from 1997 to 2006
Abstracts
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extended follow-up, and, most importantly, was independent of disease severity, PA, salt/fat intake, and liquid intake (hazard ratio [HR] ⫽ 0.36, 95% confidence interval [CI] 0.13-0.95, p⬍.04). In addition to depression, infrequent consumption of fruits/vegetables also reduced chances for improvement (p⬍.05). Conclusions: These findings suggest that targeting both depression and specific eating habits may benefit the prognosis of patients waiting for a new heart. 485 Hospital Charges for Pediatric Heart Transplant Hospitalizations in the United States from 1997 to 2006 J.W. Rossano,1 S. Law,1 J.A. Decker,1 J.F. Price,1 A.G. Cabrera,1 D.E. Graves,2 D.L.S. Morales,3 J.S. Heinle,3 S.W. Denfield,1 W.J. Dreyer,1 J.J. Kim.1 1Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX; 2Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX; 3Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX. Purpose: Heart transplantation remains a resource intensive therapy for children. However, data regarding change in costs over time remain scarce. We aimed to test the hypothesis that hospital charges for pediatric heart transplant (PHT) hospitalizations would increase from 1997 to 2006. Factors associated with hospital charges were also assessed. Methods and Materials: A retrospective analysis of the Healthcare Cost and Utilization Project Kids’ Inpatient Database was performed on admissions surrounding PHT for the years 1997, 2000, 2003, and 2006. The database is a nationwide sampling of pediatric hospital discharges and is weighted to provide national estimates. Results: In 2000 there were 353 (95%CI 201-505) PHT and in 2006 there were 355 (95%CI 226-485). Mean hospital charges increased from $279,399 in 1997 to $451,738 in 2006 (p⬍0.001). Morbidities increased during this time period including pulmonary hypertension, sepsis, and acute renal failure (p⬍ 0.05 for all). Increases were also seen in the use of ECMO and ventricular assist devices (VAD) (p⬍0.05 for both). On multivariable analysis greater hospital charges were associated with later calendar year (p⫽0.001), stroke (p⫽0.03), sepsis (p⫽0.001), ECMO (p⬍0.001), and VAD (p⬍0.001).
Purpose: Self-care agency, defined as the capability and willingness of lung transplant recipients (LTRs) to engage in self-care behaviors (e.g., home monitoring, adherence, and communicating with transplant providers), is crucial to prevent and detect complications. However, little is known about the level of self-care agency and its predictors among LTRs at the time of transplant. We examined self-care agency and potential predictive factors to better identify LTRs prior to discharge who may need assistance performing self-care behaviors. Methods and Materials: 111 LTRs were interviewed prior to discharge from their transplant hospitalization to assess self-care agency (using the 53-item Perception of Self-Care Agency Scale with a score range of 0-265; higher scores indicate a higher level of self-care agency), and potential predictors (socio-demographics, symptoms of psychiatric distress, quality of relationship with primary lay caregiver, and health locus of control). Pearson correlation coefficients were used to identify significant correlates of self-care agency and to examine collinearity among potential predictors. Multiple linear regression was used to identify significant predictors of self-care agency. Results: Mean levels of self-care agency were 223⫾22. Statistically significant correlations were found between self-care agency and quality of caregiver relationship (r ⫽ 0.19, p ⫽.04), marital status (r ⫽ ⫺.19, p⫽.045), chance locus of control (r ⫽ ⫺.22, p ⫽.02) and presence of psychiatric distress (r ⫽ ⫺.378, p⬍ .001). A multiple regression model containing marital status, chance, and clinically significant distress explained 22% of the variance in self-care agency. After controlling for marital status and chance, clinically significant distress was a significant predictor of self-care agency. Conclusions: LTRs demonstrated high levels of self-care agency; however LTRs with evidence of psychiatric distress were at higher risk for lower levels of self-care agency and thus may need additional support to perform the self-care behaviors expected of LTRs after transplantation. 487
Table 1 Characteristics of pediatric heart transplant hospitalizations
Transplants Mean charges* Mean length of stay, days Hospital mortality Pulmonary hypertension* Sepsis* Acute renal failure* ECMO* VAD*
J.K. Bhama,4 C.A. Bermudez,4 Y. Toyoda.4 1Nursing, University of Pittsburgh, Pittsburgh, PA; 2Psychiatry, Psychology, Epidmiology, University of Pittsburgh, Pittsburgh, PA; 3Nursing, UNC-Chapel Hill, Chapel Hill, NC; 4CT Surgery, University of Pittsburgh, Pittsburgh, PA; 5 Pulmonary, Allergy, Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
1997
2000
2003
2006
353 $279,399 44
287 $287,737 43
297 $390,571 57
355 $451,738 52
11% 20%
6% 20%
6% 27%
7% 29%
9% 11% 9% 5%
11% 14% 7% 7%
11% 16% 12% 9%
19% 19% 18% 12%
*Indicates increase over years significant (p⬍0.05)
Conclusions: From 1997 to 2006, mean charges for PHT hospitalizations increased by ⬎ $170,000. Though morbidities were greater in later years of the study, calendar year was independently associated with increased charges. Ongoing study of management strategies is needed to improve the morbidity, mortality, and cost of caring for PHT patients. 486 Self-Care Agency and Its Predictors among Lung Transplant Recipients A. DeVito Dabbs,1 M.A. Dew,2 L. Terhorst,1 M.-K. Song,3 J. Aubrecht,1 R. Zomak,4 D. Zaldonis,4 M. Crespo,5 B.A. Johnson,5 J.M. Pilewski,5
Trends in Health Disparities among Left Ventricular Assist Device Recipients in the United States: An Analysis of the Centers for Medicare and Medicaid Services Database A. Iribarne,1 K.N. Hong,1 M.J. Russo,2 R. Easterwood,1 K. Su,3 N. Egorova,3 A.A. Moskowitz,3 Y. Naka,1 D.D. Ascheim,3 A.C. Gelijns.3 1 Department of Surgery, Columbia University Medical Center, New York, NY; 2Section of Cardiac and Thoracic Surgery, The University of Chicago, Chicago, IL; 3Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, NY. Purpose: To assess trends in race and gender disparities among left ventricular assist (LVAD) recipients in the US. Methods and Materials: De-identified inpatient claims data were obtained from the Centers for Medicare and Medicaid services (CMS) from 1/1/01-12/31/05. A total of 1,409 LVAD recipients were included in the analysis (intracorporeal⫽804, extracorporeal⫽605). CMS race categories were collapsed into white and non-white groups. The Cochran-Armitage statistic was used to test for linear trends in proportions by year. Secondary outcomes among intracorporeal patients included: 30-day survival, length of stay (LOS), and cost of hospitalization. Results: There were 266 non-white (18.9%) and 410 female (29.1%) patients who received an LVAD during the study period. While there was a difference in the proportion of non-white recipients between years (p⫽0.029), the trend was non-linear (p⫽0.11). The proportion of female recipients did not vary between years (p⫽0.652) [fig1]. Riskadjusted 30-day mortality was not associated with race (p⫽0.505), but women were at an increased risk of death at 30 days (OR⫽2.3 [1.5-3.3], p⬍0.001). Non-white patients had a 16.6⫾5.1 day longer LOS (p⫽0.001) and an associated $95,847⫾38,891 higher cost of hospital-
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extended follow-up, and, most importantly, was independent of disease severity, PA, salt/fat intake, and liquid intake (hazard ratio [HR] ⫽ 0.36, 95% confidence interval [CI] 0.13-0.95, p⬍.04). In addition to depression, infrequent consumption of fruits/vegetables also reduced chances for improvement (p⬍.05). Conclusions: These findings suggest that targeting both depression and specific eating habits may benefit the prognosis of patients waiting for a new heart. 485 Hospital Charges for Pediatric Heart Transplant Hospitalizations in the United States from 1997 to 2006 J.W. Rossano,1 S. Law,1 J.A. Decker,1 J.F. Price,1 A.G. Cabrera,1 D.E. Graves,2 D.L.S. Morales,3 J.S. Heinle,3 S.W. Denfield,1 W.J. Dreyer,1 J.J. Kim.1 1Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX; 2Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX; 3Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX. Purpose: Heart transplantation remains a resource intensive therapy for children. However, data regarding change in costs over time remain scarce. We aimed to test the hypothesis that hospital charges for pediatric heart transplant (PHT) hospitalizations would increase from 1997 to 2006. Factors associated with hospital charges were also assessed. Methods and Materials: A retrospective analysis of the Healthcare Cost and Utilization Project Kids’ Inpatient Database was performed on admissions surrounding PHT for the years 1997, 2000, 2003, and 2006. The database is a nationwide sampling of pediatric hospital discharges and is weighted to provide national estimates. Results: In 2000 there were 353 (95%CI 201-505) PHT and in 2006 there were 355 (95%CI 226-485). Mean hospital charges increased from $279,399 in 1997 to $451,738 in 2006 (p⬍0.001). Morbidities increased during this time period including pulmonary hypertension, sepsis, and acute renal failure (p⬍ 0.05 for all). Increases were also seen in the use of ECMO and ventricular assist devices (VAD) (p⬍0.05 for both). On multivariable analysis greater hospital charges were associated with later calendar year (p⫽0.001), stroke (p⫽0.03), sepsis (p⫽0.001), ECMO (p⬍0.001), and VAD (p⬍0.001).
Purpose: Self-care agency, defined as the capability and willingness of lung transplant recipients (LTRs) to engage in self-care behaviors (e.g., home monitoring, adherence, and communicating with transplant providers), is crucial to prevent and detect complications. However, little is known about the level of self-care agency and its predictors among LTRs at the time of transplant. We examined self-care agency and potential predictive factors to better identify LTRs prior to discharge who may need assistance performing self-care behaviors. Methods and Materials: 111 LTRs were interviewed prior to discharge from their transplant hospitalization to assess self-care agency (using the 53-item Perception of Self-Care Agency Scale with a score range of 0-265; higher scores indicate a higher level of self-care agency), and potential predictors (socio-demographics, symptoms of psychiatric distress, quality of relationship with primary lay caregiver, and health locus of control). Pearson correlation coefficients were used to identify significant correlates of self-care agency and to examine collinearity among potential predictors. Multiple linear regression was used to identify significant predictors of self-care agency. Results: Mean levels of self-care agency were 223⫾22. Statistically significant correlations were found between self-care agency and quality of caregiver relationship (r ⫽ 0.19, p ⫽.04), marital status (r ⫽ ⫺.19, p⫽.045), chance locus of control (r ⫽ ⫺.22, p ⫽.02) and presence of psychiatric distress (r ⫽ ⫺.378, p⬍ .001). A multiple regression model containing marital status, chance, and clinically significant distress explained 22% of the variance in self-care agency. After controlling for marital status and chance, clinically significant distress was a significant predictor of self-care agency. Conclusions: LTRs demonstrated high levels of self-care agency; however LTRs with evidence of psychiatric distress were at higher risk for lower levels of self-care agency and thus may need additional support to perform the self-care behaviors expected of LTRs after transplantation. 487
Table 1 Characteristics of pediatric heart transplant hospitalizations
Transplants Mean charges* Mean length of stay, days Hospital mortality Pulmonary hypertension* Sepsis* Acute renal failure* ECMO* VAD*
J.K. Bhama,4 C.A. Bermudez,4 Y. Toyoda.4 1Nursing, University of Pittsburgh, Pittsburgh, PA; 2Psychiatry, Psychology, Epidmiology, University of Pittsburgh, Pittsburgh, PA; 3Nursing, UNC-Chapel Hill, Chapel Hill, NC; 4CT Surgery, University of Pittsburgh, Pittsburgh, PA; 5 Pulmonary, Allergy, Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
1997
2000
2003
2006
353 $279,399 44
287 $287,737 43
297 $390,571 57
355 $451,738 52
11% 20%
6% 20%
6% 27%
7% 29%
9% 11% 9% 5%
11% 14% 7% 7%
11% 16% 12% 9%
19% 19% 18% 12%
*Indicates increase over years significant (p⬍0.05)
Conclusions: From 1997 to 2006, mean charges for PHT hospitalizations increased by ⬎ $170,000. Though morbidities were greater in later years of the study, calendar year was independently associated with increased charges. Ongoing study of management strategies is needed to improve the morbidity, mortality, and cost of caring for PHT patients. 486 Self-Care Agency and Its Predictors among Lung Transplant Recipients A. DeVito Dabbs,1 M.A. Dew,2 L. Terhorst,1 M.-K. Song,3 J. Aubrecht,1 R. Zomak,4 D. Zaldonis,4 M. Crespo,5 B.A. Johnson,5 J.M. Pilewski,5
Trends in Health Disparities among Left Ventricular Assist Device Recipients in the United States: An Analysis of the Centers for Medicare and Medicaid Services Database A. Iribarne,1 K.N. Hong,1 M.J. Russo,2 R. Easterwood,1 K. Su,3 N. Egorova,3 A.A. Moskowitz,3 Y. Naka,1 D.D. Ascheim,3 A.C. Gelijns.3 1 Department of Surgery, Columbia University Medical Center, New York, NY; 2Section of Cardiac and Thoracic Surgery, The University of Chicago, Chicago, IL; 3Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, NY. Purpose: To assess trends in race and gender disparities among left ventricular assist (LVAD) recipients in the US. Methods and Materials: De-identified inpatient claims data were obtained from the Centers for Medicare and Medicaid services (CMS) from 1/1/01-12/31/05. A total of 1,409 LVAD recipients were included in the analysis (intracorporeal⫽804, extracorporeal⫽605). CMS race categories were collapsed into white and non-white groups. The Cochran-Armitage statistic was used to test for linear trends in proportions by year. Secondary outcomes among intracorporeal patients included: 30-day survival, length of stay (LOS), and cost of hospitalization. Results: There were 266 non-white (18.9%) and 410 female (29.1%) patients who received an LVAD during the study period. While there was a difference in the proportion of non-white recipients between years (p⫽0.029), the trend was non-linear (p⫽0.11). The proportion of female recipients did not vary between years (p⫽0.652) [fig1]. Riskadjusted 30-day mortality was not associated with race (p⫽0.505), but women were at an increased risk of death at 30 days (OR⫽2.3 [1.5-3.3], p⬍0.001). Non-white patients had a 16.6⫾5.1 day longer LOS (p⫽0.001) and an associated $95,847⫾38,891 higher cost of hospital-