Background. Administrative outcomes such as LOS and charges are used to compare the quality of care across institutions and among individual providers. Clinical variables representing disease severity may explain some of the variability in these outcomes. Objective: To determine the extent to which readily available clinical data can explain the variability in LOS and charges for children with cancer hospitalized for FN. Methods. A retrospective cohort of 160 FN encounters in a single institution during eleven months in 1997 was identified. Models predicting log LOS and log charges were developed using multiple linear regression. The "smearing" technique of Duan adjusted for logarithmic retransformation in calculating each subject's predicted LOS and charges. R2 values were calculated. Results. Mean LOS was 6.44 days (median=5.00, range 2 to 50). Mean charges were $11,979 (median=$7,865, range $955 to $121,259). Admission absolute monocyte count (<100/µL) and localized infection were significant, independent positive predictors of LOS and charges. Underlying cancer diagnosis also was significant. LOS was highest for acute myeloid leukemia (AML), followed by CNS tumors, acute lymphoblastic leukemia (ALL) and lymphomas, and other solid tumors. Charges were highest for AML, followed by CNS tumors, other solid tumors, and ALL and lymphomas. R2 was ~25% for each model. Conclusion. The clinical variables used in this study account for 25% of the variability for LOS and charges for encounters for FN. Adjusting LOS and charges for these clinical variables would allow for a fairer comparison of institutions and individual providers.
Learning Objectives: At the conclusion of this session, the participant will be able to identify readily available clinical variables that influence administrative outcomes in children with cancer hospitalized for fever and neutropenia
Keywords: Medical Care,
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.