title: Effects of health care cost-containment programs on patterns of care and readmissions among children and adolescents.
abstract: OBJECTIVE
  This study examined the effects of a utilization management program on patterns of medical care among children and adolescents.
  
  
  METHODS
  From 1989 through 1993, the program conducted 8568 reviews of pediatric patients, ranging in age from birth to 18 years. The program used preadmission and concurrent review procedures to review and certify patients' need for care. This study used multivariate analyses to assess changes in the number of days of inpatient care approved by the program and to determine whether limitations imposed on length of stay affected the risk of 60-day readmission.
  
  
  RESULTS
  Concurrent review reduced the number of requested days of inpatient care by 3.2 days per patient. Low-birthweight infants and adolescent patients with depression or alcohol or drug dependence accounted for a disproportionate share of the reduction. Patients classified as admitted for medical or mental health care and whose stay was restricted by concurrent review were more likely (P < .05) to be readmitted within 60 days after discharge.
  
  
  CONCLUSIONS
  By limiting care through its review procedures, the utilization management program decreased inpatient resource consumption but also increased the risk of readmission for some patients. Continued investigation should be conducted of the effects of cost-containment programs on the quality of care given to children and adolescents, especially in the area of mental health.
authors.affiliation: Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle 98195-7660, USA. tomwick@u.washington.edu
authors.forename: T M
authors.initials: TM
authors.lastname: Wickizer
authors.forename: D
authors.initials: D
authors.lastname: Lessler
authors.forename: J
authors.initials: J
authors.lastname: Boyd-Wickizer
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003211:Concurrent Review; D003363:Cost Control; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D014481:United States