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Time to send the preemie home? Additional maturity at discharge and subsequent health care costs and outcomes

OBJECTIVE: To determine whether longer stays of premature infants allowing for increased physical maturity result in subsequent postdischarge cost savings that help counterbalance increased inpatient costs. DATA SOURCES: One thousand four hundred and two premature infants born in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2002. STUDY DESIGN/METHODS: Using multivariate matching with a time-dependent propensity score we matched 701 ‘Early’ babies to 701 ‘Late’ babies (developmentally similar at the time the earlier baby was sent home but who were discharged on average 3 days later) and assessed subsequent costs and clinical outcomes. PRINCIPAL FINDINGS: Late babies accrued inpatient costs after the Early baby was already home, yet costs after discharge through 6 months were virtually identical across groups, as were clinical outcomes. Overall, after the Early baby went home, the Late-Early cost difference was $5,016 (p.0001). A sensitivity analysis suggests our conclusions would not easily be altered by failure to match on some unmeasured covariate. CONCLUSIONS: In a large integrated health care system, if a baby is ready for discharge (as defined by the typical criteria), staying longer increased inpatient costs but did not reduce postdischarge costs nor improve postdischarge clinical outcomes.

Authors: Silber JH; Lorch SA; Rosenbaum PR; Medoff-Cooper B; Bakewell-Sachs S; Millman A; Mi L; Even-Shoshan O; Escobar GJ

Health Serv Res. 2009 Apr;44(2 Pt 1):444-63. Epub 2008 Dec 31.

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