Time to send the preemie home? Additional maturity at discharge and subsequent health care costs and outcomes.
OBJECTIVE
To determine whether longer stays of premature infants allowing for increased physical maturity result in subsequent postdischarge cost savings that help counterbalance increased inpatient costs.


METHODS
One thousand four hundred and two premature infants born in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2002.


METHODS
Using multivariate matching with a time-dependent propensity score we matched 701 "Early" babies to 701 "Late" babies (developmentally similar at the time the earlier baby was sent home but who were discharged on average 3 days later) and assessed subsequent costs and clinical outcomes.


RESULTS
Late babies accrued inpatient costs after the Early baby was already home, yet costs after discharge through 6 months were virtually identical across groups, as were clinical outcomes. Overall, after the Early baby went home, the Late-Early cost difference was $5,016 (p<.0001). A sensitivity analysis suggests our conclusions would not easily be altered by failure to match on some unmeasured covariate.


CONCLUSIONS
In a large integrated health care system, if a baby is ready for discharge (as defined by the typical criteria), staying longer increased inpatient costs but did not reduce postdischarge costs nor improve postdischarge clinical outcomes.
Silber
Jeffrey H
JH
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. silberj@wharton.upenn.edu
Lorch
Scott A
SA
Rosenbaum
Paul R
PR
Medoff-Cooper
Barbara
B
Bakewell-Sachs
Susan
S
Millman
Andrea
A
Mi
Lanyu
L
Even-Shoshan
Orit
O
Escobar
Gabriel J
GJ
D000465:Algorithms; D002140:California; D017046:Cost Savings; D003365:Costs and Cost Analysis; D005102:Health Expenditures; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007902:Length of Stay / Q000191:economics; D017063:Outcome Assessment, Health Care / Q000191:economics; D010351:Patient Discharge / Q000191:economics*