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Acute Pancreatitis Regional and Divisional Cost Variations Throughout the United States: A 10-Year Nationwide analysis
AGA Abstracts
Of the many factors that can delay discharge after treatment of UGIB, treatment of comorbidities is substantial. While efforts should be made to reduce preventable delays in discharge, the effect on overall costs would likely be small.
Figure 1 - Geographical variation in total hospitalization charges and hospital costs of treating acute pancreatitis Su1019 Su1021
ACUTE PANCREATITIS REGIONAL AND DIVISIONAL COST VARIATIONS THROUGHOUT THE UNITED STATES: A 10-YEAR NATIONWIDE ANALYSIS Paul T. Kroner, Pichamol Jirapinyo, Marwan S. Abougergi, Christopher C. Thompson
A SUCCESSFUL PHARMACIST BASED QUALITY INITIATIVE TO REDUCE INAPPROPRIATE USE OF STRESS ULCER PROPHYLAXIS IN AN ACADEMIC MEDICAL INTENSIVE CARE UNIT Umair Masood, Anuj Sharma, Zabeer Bhatti, Jessica Carroll, Amit Bhardwaj, Amit Dhamoon
Background Acute pancreatitis (AP) continues to represent a significant economic burden to the healthcare system, with a yearly expenditure of over $2 billion. Expenditures in the U.S. healthcare system vary significantly between the different geographical regions, which is reflected in regional differences of per-capita expenditures. Although some studies have also suggested interstate differences, these are relatively small, limited to a single year of analysis, or with limited number of outcomes. The aim of this study was to examine the difference in regional and divisional cost variation throughout the past decade in the United States using a national database. Methods Retrospective cohort study using the National inpatient sample from 2004 to 2013, which is the largest publically available inpatient database in the US. All patients with an ICD-9CM code for a principal diagnosis code of AP were included in the study. There were no exclusion criteria. The US Census Bureau regional divisions were used to establish the geographical areas examined. The primary outcome was regional cost variation, measured in yearly total hospitalization charges and total hospital costs (adjusted for inflation). The secondary outcome was regional variation in hospital length of stay (LOS). Cost and length of stay trend analysis was performed with linear regression. Means were compared using Student's t-test. Results A total of 2,690,774 patients were diagnosed with acute pancreatitis (AP) during the study period and were included in the study. Mean age was 51 years and 48% of patients were female. For the primary outcome after adjusting for inflation, total hospitalization charges decreased from $35,749 to $31,641 (p=0.04). Similarly, total hospital costs decreased from $10,875 to $9,995 (p=0.01). On average, total hospitalization charges were highest in the South Atlantic division, while total hospital costs were highest in the Pacific division. Table 1 shows the regional cost variations in AP management throughout the U.S. divisions. For the secondary outcome, hospital length of stay decreased from 5.6 to 4.6 days (p<0.01). Patients in the Mid-Atlantic division had the longest length of stay, with an average of 5.8 days. Conclusion Although the length of stay and overall cost of acute pancreatitis management has significantly decreased nationally over the past decade there are substantial regional and divisional variations. While total hospital costs were not significantly different among the 9 regions, striking differences exist in terms of total hospital charges among them. Reasons for this are not entirely unclear, although it could reflect regional differences in reimbursement models or expected reimbursement rates. Table 1 - Region divisional total hospital costs, hospitalization charges and length of stay distribution
Introduction Stress ulcer prophylaxis (SUP) is a widely utilized practice in hospitalized patients particularly in the intensive care unit (ICU). While there are certain patients who are at increased risk of gastrointestinal bleeding in the ICU, there is a trend towards inappropriate utilization of this practice. Proton pump inhibitors (PPIs) are the widely accepted choice of medication. As their use is becoming more and more common, their side effect profile has been expanding vastly. Increased risk of Clostridium Difficile infection, liver toxicity, and vitamin b12 deficiency are only a few on a growing list. The purpose of this study is to find an effective way to decrease inappropriate use of SUP in an academic medical ICU. Methods Medical ICU patients who received SUP either with proton pump inhibitors or anti-histamines during the month of May were first identified. Patients who were admitted for acute gastrointestinal bleeds were excluded. A thorough chart review was then performed to identify their indications. Guidelines from the American Society of Health System Pharmacists were used to judge the appropriateness of SUP. After obtaining initial data to identify the issue, a pharmacist based quality initiative was started. Pharmacists reviewed patients on SUP during medical ICU rounds and daily chart reviews to identify patients on SUP and notified the team to make appropriate changes. Residents and fellows were educated on the indications of SUP on bi-monthly bases upon start of their ICU rotations. Post intervention data for the month of October was then obtained in a similar fashion to infer if there was a decrease in the inappropriate use of SUP. Results Data analysis showed that 42.86 % of the patients (n = 140) in the medical ICU receiving SUP were receiving it inappropriately prior to our intervention. Total cost amounting to the inappropriate use was approximately $ 2433. Post intervention, we were able to decrease the inappropriate rate to 12.24% (n = 98). In addition, total cost amounting to the inappropriate use was reduced to $ 239.80. We also noticed that while 67.96 %of the total patients ((n = 206) were given SUP prior to intervention, 58.68 %of the total patients (n = 167) were given SUP after the intervention. Conclusion Our study showed a successful approach to reduce inappropriate use of SUP in a medical ICU. Since education is considered a weak and nonsustainable intervention in a quality initiative, we went a step further and involved our pharmacy team to strengthen our approach. We were able to reduce inappropriate use of SUP by 71.44 % (p-value = 0.0001). Furthermore, we were able to decrease the costs by approximately $ 2200 for the duration of a month alone. Due to significant findings of this project, we plan on expanding this approach to other ICUs in the hospital.
Bar graph depiction of data showing decrease in inappropriate stress ulcer prophyalxis use after intervention.
Data showing decrease in inappropriate stress ulcer prophyalxis use and associated costs after intervention.
S-445
AGA Abstracts
Of the many factors that can delay discharge after treatment of UGIB, treatment of comorbidities is substantial. While efforts should be made to reduce preventable delays in discharge, the effect on overall costs would likely be small.
Figure 1 - Geographical variation in total hospitalization charges and hospital costs of treating acute pancreatitis Su1019 Su1021
ACUTE PANCREATITIS REGIONAL AND DIVISIONAL COST VARIATIONS THROUGHOUT THE UNITED STATES: A 10-YEAR NATIONWIDE ANALYSIS Paul T. Kroner, Pichamol Jirapinyo, Marwan S. Abougergi, Christopher C. Thompson
A SUCCESSFUL PHARMACIST BASED QUALITY INITIATIVE TO REDUCE INAPPROPRIATE USE OF STRESS ULCER PROPHYLAXIS IN AN ACADEMIC MEDICAL INTENSIVE CARE UNIT Umair Masood, Anuj Sharma, Zabeer Bhatti, Jessica Carroll, Amit Bhardwaj, Amit Dhamoon
Background Acute pancreatitis (AP) continues to represent a significant economic burden to the healthcare system, with a yearly expenditure of over $2 billion. Expenditures in the U.S. healthcare system vary significantly between the different geographical regions, which is reflected in regional differences of per-capita expenditures. Although some studies have also suggested interstate differences, these are relatively small, limited to a single year of analysis, or with limited number of outcomes. The aim of this study was to examine the difference in regional and divisional cost variation throughout the past decade in the United States using a national database. Methods Retrospective cohort study using the National inpatient sample from 2004 to 2013, which is the largest publically available inpatient database in the US. All patients with an ICD-9CM code for a principal diagnosis code of AP were included in the study. There were no exclusion criteria. The US Census Bureau regional divisions were used to establish the geographical areas examined. The primary outcome was regional cost variation, measured in yearly total hospitalization charges and total hospital costs (adjusted for inflation). The secondary outcome was regional variation in hospital length of stay (LOS). Cost and length of stay trend analysis was performed with linear regression. Means were compared using Student's t-test. Results A total of 2,690,774 patients were diagnosed with acute pancreatitis (AP) during the study period and were included in the study. Mean age was 51 years and 48% of patients were female. For the primary outcome after adjusting for inflation, total hospitalization charges decreased from $35,749 to $31,641 (p=0.04). Similarly, total hospital costs decreased from $10,875 to $9,995 (p=0.01). On average, total hospitalization charges were highest in the South Atlantic division, while total hospital costs were highest in the Pacific division. Table 1 shows the regional cost variations in AP management throughout the U.S. divisions. For the secondary outcome, hospital length of stay decreased from 5.6 to 4.6 days (p<0.01). Patients in the Mid-Atlantic division had the longest length of stay, with an average of 5.8 days. Conclusion Although the length of stay and overall cost of acute pancreatitis management has significantly decreased nationally over the past decade there are substantial regional and divisional variations. While total hospital costs were not significantly different among the 9 regions, striking differences exist in terms of total hospital charges among them. Reasons for this are not entirely unclear, although it could reflect regional differences in reimbursement models or expected reimbursement rates. Table 1 - Region divisional total hospital costs, hospitalization charges and length of stay distribution
Introduction Stress ulcer prophylaxis (SUP) is a widely utilized practice in hospitalized patients particularly in the intensive care unit (ICU). While there are certain patients who are at increased risk of gastrointestinal bleeding in the ICU, there is a trend towards inappropriate utilization of this practice. Proton pump inhibitors (PPIs) are the widely accepted choice of medication. As their use is becoming more and more common, their side effect profile has been expanding vastly. Increased risk of Clostridium Difficile infection, liver toxicity, and vitamin b12 deficiency are only a few on a growing list. The purpose of this study is to find an effective way to decrease inappropriate use of SUP in an academic medical ICU. Methods Medical ICU patients who received SUP either with proton pump inhibitors or anti-histamines during the month of May were first identified. Patients who were admitted for acute gastrointestinal bleeds were excluded. A thorough chart review was then performed to identify their indications. Guidelines from the American Society of Health System Pharmacists were used to judge the appropriateness of SUP. After obtaining initial data to identify the issue, a pharmacist based quality initiative was started. Pharmacists reviewed patients on SUP during medical ICU rounds and daily chart reviews to identify patients on SUP and notified the team to make appropriate changes. Residents and fellows were educated on the indications of SUP on bi-monthly bases upon start of their ICU rotations. Post intervention data for the month of October was then obtained in a similar fashion to infer if there was a decrease in the inappropriate use of SUP. Results Data analysis showed that 42.86 % of the patients (n = 140) in the medical ICU receiving SUP were receiving it inappropriately prior to our intervention. Total cost amounting to the inappropriate use was approximately $ 2433. Post intervention, we were able to decrease the inappropriate rate to 12.24% (n = 98). In addition, total cost amounting to the inappropriate use was reduced to $ 239.80. We also noticed that while 67.96 %of the total patients ((n = 206) were given SUP prior to intervention, 58.68 %of the total patients (n = 167) were given SUP after the intervention. Conclusion Our study showed a successful approach to reduce inappropriate use of SUP in a medical ICU. Since education is considered a weak and nonsustainable intervention in a quality initiative, we went a step further and involved our pharmacy team to strengthen our approach. We were able to reduce inappropriate use of SUP by 71.44 % (p-value = 0.0001). Furthermore, we were able to decrease the costs by approximately $ 2200 for the duration of a month alone. Due to significant findings of this project, we plan on expanding this approach to other ICUs in the hospital.
Bar graph depiction of data showing decrease in inappropriate stress ulcer prophyalxis use after intervention.
Data showing decrease in inappropriate stress ulcer prophyalxis use and associated costs after intervention.
S-445
AGA Abstracts