Browsing by Author "Hall, Matt"

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    Epidemiology of Pediatric Critical Care Admissions in 43 United States Children’s Hospitals, 2014-2019
    (Wolters Kluwer, 2022-07) Heneghan, Julia A.; Rogerson , Colin; Goodman, Denise M.; Hall, Matt; Kohne, Joseph G.; Kane, Jason M.; Pediatrics, School of Medicine
    OBJECTIVES: To identify trends in the population of patients in PICUs over time. DESIGN: Cross-sectional, retrospective cohort study using the Pediatric Health Information System database. SETTING: Forty-three U.S. children’s hospitals. PATIENTS: All patients admitted to Pediatric Health Information System-participating hospitals from January 2014 to December 2019. Individuals greater than 65 years old and normal newborns were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: PICU care occurred in 13.8% of all pediatric hospital encounters and increased over the study period from 13.3% to 14.3%. Resource intensity, based on average Hospitalization Resource Intensity Scores for Kids score, increased significantly across epochs (6.5 in 2014–2015 vs 6.9 in 2018–2019; p < 0.001), although this was not consistently manifested as additional procedural exposure. Geometric mean PICU cost per patient encounter was stable. The two most common disease categories in PICU patients were respiratory failure and cardiac and circulatory congenital anomalies. Of all PICU encounters, 35.5% involved mechanical ventilation, and 25.9% involved vasoactive infusions. Hospital-level variation in the percentage of days spent in the PICU ranged from 15.1% to 63.5% across the participating sites. Of the total hospital costs for patients admitted to the PICU, 41.7% of costs were accrued during the patients’ PICU stay. CONCLUSIONS: The proportional use of PICU beds is increasing over time, although was variable across centers. Case-based resource use and complexity of pediatric patients are also increasing. Despite the higher use of PICU resources, the standardized costs of PICU care per patient encounter have remained stable. These data may help to inform current PICU resource allocation and future PICU capacity planning.
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    Healthcare utilization and spending by children with cancer on Medicaid
    (Wiley, 2017-11) Mueller, Emily L.; Hall, Matt; Berry, Jay G.; Carroll, Aaron E.; Macy, Michelle L.; Medicine, School of Medicine
    Background Children with cancer are a unique patient population with high resource, complex healthcare needs. Understanding their healthcare utilization could highlight areas for care optimization. Procedure We performed a retrospective, cross-sectional analysis of the 2014 Truven Marketscan Medicaid Database to explore clinical attributes, utilization, and spending among children with cancer who were Medicaid enrollees. Eligible patients included children (ages 0–18 years) with cancer (Clinical Risk Group 8). Healthcare utilization and spending (per member per month, PMPM) were assessed overall and across specific healthcare services. Results Children with cancer (n = 5,405) represent less than 1% of the 1,516,457 children with medical complexity in the dataset. Children with cancer had high services use: laboratory/radiographic testing (93.0%), outpatient specialty care (83.4%), outpatient therapy/treatment (53.4%), emergency department (43.7%), hospitalization (31.5%), home healthcare (9.5%). PMPM spending for children with cancer was $3,706 overall and $2,323 for hospital care. Conclusion Children with cancer have high healthcare resource use and spending. Differences in geographic distribution of services for children with cancer and the trajectory of spending over the course of therapy are areas for future investigation aimed at lowering costs of care without compromising on health outcomes.
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    Identifying and Validating Pediatric Hospitalizations for MIS-C Through Administrative Data
    (American Academy of Pediatrics, 2023) Auger, Katherine A.; Hall, Matt; Arnold, Staci D.; Bhumbra, Samina; Bryan, Mersine A.; Hartley, David; Ivancie, Rebecca; Katragadda, Harita; Kazmier, Katie; Jacob, Seethal A.; Jerardi, Karen E.; Molloy, Matthew J.; Parikh, Kavita; Schondelmeyer, Amanda C.; Shah, Samir S.; Brady, Patrick W.; Medicine, School of Medicine
    Background: Individual children's hospitals care for a small number of patients with multisystem inflammatory syndrome in children (MIS-C). Administrative databases offer an opportunity to conduct generalizable research; however, identifying patients with MIS-C is challenging. Methods: We developed and validated algorithms to identify MIS-C hospitalizations in administrative databases. We developed 10 approaches using diagnostic codes and medication billing data and applied them to the Pediatric Health Information System from January 2020 to August 2021. We reviewed medical records at 7 geographically diverse hospitals to compare potential cases of MIS-C identified by algorithms to each participating hospital's list of patients with MIS-C (used for public health reporting). Results: The sites had 245 hospitalizations for MIS-C in 2020 and 358 additional MIS-C hospitalizations through August 2021. One algorithm for the identification of cases in 2020 had a sensitivity of 82%, a low false positive rate of 22%, and a positive predictive value (PPV) of 78%. For hospitalizations in 2021, the sensitivity of the MIS-C diagnosis code was 98% with 84% PPV. Conclusion: We developed high-sensitivity algorithms to use for epidemiologic research and high-PPV algorithms for comparative effectiveness research. Accurate algorithms to identify MIS-C hospitalizations can facilitate important research for understanding this novel entity as it evolves during new waves.
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    A Prospective Multicenter Study Evaluating Learning Curves and Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography Among Advanced Endoscopy Trainees: The Rapid Assessment of Trainee Endoscopy Skills (RATES) Study
    (Elsevier, 2017) Wani, Sachin; Keswani, Rajesh; Hall, Matt; Han, Samuel; Ali, Meer Akbar; Brauer, Brian; Carlin, Linda; Chak, Amitabh; Collins, Dan; Cote, Gregory A.; Diehl, David L.; DiMaio, Christopher J.; Dries, Andrew; El-Hajj, Ihab; Ellert, Swan; Fairley, Kimberley; Faulx, Ashley; Fujii-Lau, Larissa; Gaddam, Srinivas; Gan, Seng-Ian; Gaspar, Jonathan P.; Gautamy, Chitiki; Gordon, Stuart; Harris, Cynthia; Hyder, Sarah; Jones, Ross; Kim, Stephen; Komanduri, Srinadh; Law, Ryan; Lee, Linda; Mounzer, Rawad; Mullady, Daniel; Muthusamy, V. Raman; Olyaee, Mojtaba; Pfau, Patrick; Saligram, Shreyas; Piraka, Cyrus; Rastogi, Amit; Rosenkranz, Laura; Rzouq, Fadi; Saxena, Aditi; Shah, Raj J.; Simon, Violette C.; Small, Aaron; Sreenarasimhaiah, Jayaprakash; Walker, Andrew; Wang, Andrew Y.; Watson, Rabindra R.; Wilson, Robert H.; Yachimski, Patrick; Yang, Dennis; Edmundowicz, Steven; Early, Dayna S.; Department of Medicine, IU School of Medicine
    Background and aims Based on the Next Accreditation System, trainee assessment should occur on a continuous basis with individualized feedback. We aimed to validate endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) learning curves among advanced endoscopy trainees (AETs) using a large national sample of training programs and to develop a centralized database that allows assessment of performance in relation to peers. Methods ASGE recognized training programs were invited to participate and AETs were graded on ERCP and EUS exams using a validated competency assessment tool that assesses technical and cognitive competence in a continuous fashion. Grading for each skill was done using a 4-point scoring system and a comprehensive data collection and reporting system was built to create learning curves using cumulative sum analysis. Individual results and benchmarking to peers were shared with AETs and trainers quarterly. Results Of the 62 programs invited, 20 programs and 22 AETs participated in this study. At the end of training, median number of EUS and ERCP performed/AET was 300 (range 155-650) and 350 (125-500). Overall, 3786 exams were graded (EUS:1137; ERCP–biliary 2280, pancreatic 369). Learning curves for individual endpoints, and overall technical/cognitive aspects in EUS and ERCP demonstrated substantial variability and were successfully shared with all programs. The majority of trainees achieved overall technical (EUS: 82%; ERCP: 60%) and cognitive (EUS: 76%; ERCP: 100%) competence at conclusion of training. Conclusions These results demonstrate the feasibility of establishing a centralized database to report individualized learning curves and confirm the substantial variability in time to achieve competence among AETs in EUS and ERCP.
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    Resources and Costs Associated With Repeated Admissions to PICUs
    (Wolters Kluwer, 2021-02-17) Kane, Jason M.; Hall, Matt; Cecil, Cara; Montgomery, Vicki L.; Rakes, Lauren C.; Rogerson, Colin; Stockwell, Jana A.; Slain, Katherine N.; Goodman, Denise M.; Pediatrics, School of Medicine
    Objective: To determine the costs and hospital resource use from all PICU patients readmitted with a PICU stay within 12 months of hospital index discharge. Design: Cross-sectional, retrospective cohort study using Pediatric Health Information System. Setting: Fifty-two tertiary children's hospitals. Subjects: Pediatric patients under 18 years old admitted to the PICU from January 1, 2016, to December 31, 2017. Interventions: None. Measurements and main results: Patient characteristics and costs of care were compared between those with readmission requiring PICU care and those with only a single PICU admission per annum. In this 2-year cohort, there were 239,157 index PICU patients of which 36,970 (15.5%) were readmitted and required PICU care during the 12 months following index admission. The total hospital cost for all index admissions and readmissions was $17.3 billion, of which 21.5% ($3.71 billion) were incurred during a readmission stay involving care in the PICU; of the 3,459,079 hospital days, 20.3% (702,200) were readmission days including those where PICU care was required. Of the readmitted patients, 11,703 (30.0%) received only PICU care, accounting for $662 million in costs and 110,215 PICU days. Although 43.6% of all costs were associated with patients who required readmission, these patients only accounted for 15.5% of the index patients and 28% of index hospitalization expenditures. More patients in the readmitted group had chronic complex conditions at index discharge compared with those not readmitted (83.9% vs 54.9%; p < 0.001). Compared with those discharged directly to home without home healthcare, patients discharged to a skilled nursing facility had 18% lower odds of readmission (odds ratio 0.82 [95% CI, 0.75-0.89]; p < 0.001) and those discharged home with home healthcare had 43% higher odds of readmission (odds ratio, 1.43 [95% CI, 1.36-1.51]; p < 0.001). Conclusions: Repeated admissions with PICU care resulted in significant direct medical costs and resource use for U.S. children's hospitals.