Pediatric Research in Inpatient Settings Network

Project Summary

The Prioritization Project will use existing detailed administrative data from 42 U.S. children's hospitals in the Pediatric Health Information System as well as over 600 hospitals in the Premier Perspectives database to identify pediatric hospital conditions that are prevalent and cumulatively expensive to the healthcare system, and that exhibit high degrees of variation in resource utilization. For a limited number of diagnoses, the Prioritization Project team will also seek explanations for extreme variation, both in terms of resource categories that may be driving variation (e.g. radiology, laboratory, or length of stay costs), and organizational factors associated with more cost-effective care (e.g. use of and adherence to clinical practice guidelines).

Specific tasks involved in the project include:

  1. Conversion of hospital charges to costs using hospital and department specific cost to charge ratios and use of those costs to create a standardized cost master index (CMI) as a basis of cost comparison across hospitals
  2. Development of a condition list that represents the top 80% of charges or admissions from the hospitals represented in the PHIS database and grouping of these conditions into diagnosis categories that would be expected to have the same management
  3. Use of the CMI to calculate standardized total admission costs by each of the conditions; and, further investigation into the sources of variability for selected conditions
  4. High variability conditions that are found to lack evidence for best practices will be targeted for comparative effectiveness research studies
  5. High variability conditions found to have solid evidence for best practices will be targeted for improved standardization of care

Objectives

Extreme variation in resource utilization across hospitals for the same condition can be an indicator of opportunities for elucidation of best practices and standardization of care, which can result in improved outcomes and reduced costs. The information gained from this project will be used to guide PRIS in prioritizing those conditions that deserve the most urgent attention for future studies.

Funding

  • The State of Pennsylvania, Health Research Formulary Fund has funded $1.6 million for this 3-year project.
  • The Child Health Corporation of American has funded $1.3 million for this 3-year project

Current Events

PAS (May 3, 2011)

A Strategy for Prioritizing Pediatric Inpatient Comparative Effectiveness Research. Raj Srivastava, MD, MPH, Ron Keren, MD, MPH, Xianqun Luan, MS, Russell Localio, PhD, Dingwei Dai, MS, Lisa McLeod, MD, Matt Hall, PhD and for the PRIS NETWORK.