Text

theses

The cost associated with healthcare has continually increased over the years especially for oncologic care and treatment of chronic conditions. The diversity of factors affecting cost and outcomes necessitates a varied approach to addressing these issues. They necessitate continuous evaluation of cost influencers and the development of strategic plans by all stakeholders in addressing this problem. This retrospective study examined various cost influencers, patient and hospital characteristics that impact care for pediatric and adolescent patients diagnosed with leukemia of lymphoid origin. Leukemia of lymphoid origin presentation in Inpatient dataset (HCUP KID) were 62,338 (2009 & 2012) and outpatient (NJSASD) were 491(2012) at ages 0-21. A comparison group with similar age, sex were selected from the dataset. Treatment-related hospitalization cost in the dataset were selected, patients and hospital characteristics identified, and their relationship was further analyzed. Mean charges of $66,955 (95 CI, $55,076-$89,382) by region could be attributed to several days increased LOS (95 CI, 3-10 days). Moreover, factors such as race, hospital size, ownership, NCHRONIC, and NDX affect these charges. This study shows the highest charges were associated with the West Region of the country, Hispanics, therapeutic procedures and individuals less than oneyear-old. Cost variation shown in this study for therapeutic and diagnostic procedures when performed in an outpatient verse’s inpatient setting could be the key to addressing the most significant factors affecting cost. Moreover, it could decrease readmittance and risk of nosocomial infections. A difference in severity by race can also be associated with household income as noted in this study. Understanding the factors that affect access to care and coverage is necessary for a broader understanding of this phenomena. Development of specific evidenced-based protocols that guides providers in deciding to transfer a patient to alternate care facilities is essential in the approach towards LOS and cost reduction. These protocols could also aid in directing low-risk procedures to oncologic outpatient settings. Such approaches could most importantly aid in outcome improvement through effective implementation of process and structural measures.

ETD_9703

doi:10.7282/t3-jpxt-qw13

Ph.D.

Includes bibliographical references

ETD doctoral

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