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theses

According to the Organization for Economic Cooperation and Development (OECD), the United States expenditure on health care exceeds all other developed countries with similar income and lifestyle. Gross Domestic Product (GDP) expenditure in the U.S. on health was 17.5% in 2016 or $10000 per capita compared to 10% GDP or $2781 in the EU. Yet, Europeans have longer life spans of 83 years in the EU versus 78 in the USA. Infant mortality is at 2.3 per 1000 live births in Scandinavian countries compared to 5.6 in the USA. Infant hospitalization and inpatient care affect a large proportion of the population and significantly impact the economy. Liveborn (newborn infant) was the most common reason for hospitalization in the U.S. from 1997-2010, accounting for more than 3.9 million stays in 2010 (10 percent of all stays). The highest hospitalization rate by age group in the country is for infants less than one year old.31 Among hospitalized adults ages 18–44, 4 of the top 5 conditions are related to pregnancy and childbirth: trauma to the perineum and vulva due to childbirth, maternal stay with a previous Cesarean section, prolonged pregnancy, and hypertension complicating pregnancy and childbirth.”31 Optimal healthcare starts just before birth at prenatal care, and the first hospitalization is at birth.
Part of healthcare effectiveness is in access or availability and utilization of available resources such as hospitalization. Hospital inpatient care cost is almost a third of all healthcare expenditure in the United States representing a significant impact on the economy.
Healthcare equity remains a national political debate with 15% or 27.4 million non-elderly Americans still uninsured in 2017 compared to other developed countries which have almost 100% universal coverage. People at increased risk of poor health are also likely to perform specific health behaviors e.g. those without health insurance, those with fewer resources, those with less education, and low health literacy, or many who are already ill. Consequently, this further contributes to increased disparities in health outcomes. According to the Kaiser Family Foundation analysis of the National Health Interview Survey of 2017, 50% uninsured, 12 % publicly insured, and 11% privately insured had no usual source of care. Respondents said their usual source of care is the emergency room.
The goal of this study is to evaluate post-neo-natal healthcare, with a focus on secondary care and social determinants as some of the factors involved in healthcare inequities for socioeconomically disadvantaged families. The objective is to investigate hospitalization for infants and some of the demographics affecting inpatients in order to identify high risk populations and improve medical outcomes in post-neo-natal health. The hypothesis is to determine whether primary diagnoses, length of stay, hospital outcomes or patient disposition, and total charges of post-neo-natal admissions differ with race, income bracket, insurance type, or geographic regions in the United States.
A Cross-Sectional Study was conducted with a population of 871845 inpatients for the years 2012-2014 with infants 28-364 days old using Hospital Cost and Utilization Project National Inpatient Sample (HCUP-NIS) data from the National Institute of Health (NIH) with length of stay and total charges as dependent variables and various components used as independent variables.
These results show that infants 28-364 days old in 2012, 2013, 2014 showed utilization of hospitals for care that may be classified as routine 92.7% of the time. 75% were with low risk of dying, 45% with minor loss of function, over 96% were not under major substances of abuse, 58% did not require any procedures, 53% did not have chronic morbidities, and 45% were not even eligible for emergency room billing. The total charges accrued were paid for by Medicaid as primary payer 64% of the time, and private insurance 30% of the time. Over a third (37%) of inpatients came from the lowest household median income in the country (0- 25000 zip quartile income percentile) and a quarter (25%) were of the next level (25-60000 zip quartile income). Regional dynamics accounted for variations in mean total charges of $27,704.45 in the East South Central region to $61,911.58 in the Pacific per length of stay (LOS). The mean LOS was 4.72 days and sum total charges nationally were $34,727,880,784. The covariance showed that 85% length of stay an 82% of total charges are explained by the various independent variables collectively in the regressions and they are comprised of social determinants of health, hospital based activities, and patient centered components.
The diagnoses were primarily respiratory with the majority of patients not requiring any procedure during their stay at hospital. There needs to be a continuous real time root cause analysis of hospitalization upon admission and post discharge in order to optimize and personalize transition of care 30 days post discharge. An improved care process and a unified patient portal to connect multiple providers with the patient would diffuse health care to patients giving them ownership of their health. In order to improve medical outcomes, service delivery outcomes, and cost outcomes, an evolving clinical process model or Learning Health System must be established and link post-neo-natal care with postpartum care to address Infant Mortality Rates and Maternal Mortality Rates in the US.
Utilizing secondary care facilities and resources for what otherwise can be done at primary care settings is expensive and duplicative effort that could be redirected to recycle spending, improve operational efficiency and ultimately improve health outcomes throughout the health system. Whether these routine hospital visits were a result of gaps in healthcare, social determinants, or individual behavior, they consume effort needed elsewhere and impact spending and resource consumption in an already strained system. A more comprehensive landscape is possible by integrating datasets from other sources like county data for environmental input, neighborhood crime or violence level, census data, education, housing, transportation, communication data. In order to compile long term patient profiles for health, one must conduct risk stratification and take into account multifactorial health outcomes endogenously; from clinical care and genomics, and exogenously; from socioeconomic data, social determinants of health, environmental factors, and individual behavior patterns.

ETD_9958

Ph.D.

Includes bibliographical references

doi:10.7282/t3-06gv-k476

ETD doctoral

The author owns the copyright to this work.