title: Prioritization of comparative effectiveness research topics in hospital pediatrics.
abstract: OBJECTIVE
  To use information about prevalence, cost, and variation in resource utilization to prioritize comparative effectiveness research topics in hospital pediatrics.
  
  
  METHODS
  Retrospective analysis of administrative and billing data for hospital encounters.
  
  
  METHODS
  Thirty-eight freestanding US children's hospitals from January 1, 2004, through December 31, 2009.
  
  
  METHODS
  Children hospitalized with conditions that accounted for either 80% of all encounters or 80% of all charges.
  
  
  METHODS
  Condition-specific prevalence, total standardized cost, and interhospital variation in mean standardized cost per encounter, measured in 2 ways: (1) intraclass correlation coefficient, which represents the fraction of total variation in standardized costs per encounter due to variation between hospitals; and (2) number of outlier hospitals, defined as having more than 30% of encounters with standardized costs in either the lowest or highest quintile across all encounters.
  
  
  RESULTS
  Among 495 conditions accounting for 80% of all charges, the 10 most expensive conditions accounted for 36% of all standardized costs. Among the 50 most prevalent and 50 most costly conditions (77 in total), 26 had intraclass correlation coefficients higher than 0.10 and 5 had intraclass correlation coefficients higher than 0.30. For 10 conditions, more than half of the hospitals met outlier hospital criteria. Surgical procedures for hypertrophy of tonsils and adenoids, otitis media, and acute appendicitis without peritonitis were high cost, were high prevalence, and displayed significant variation in interhospital cost per encounter.
  
  
  CONCLUSIONS
  Detailed administrative and billing data can be used to standardize hospital costs and identify high-priority conditions for comparative effectiveness research--those that are high cost, are high prevalence, and demonstrate high variation in resource utilization.
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA. keren@email.chop.edu
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.forename: Xianqun
authors.initials: X
authors.lastname: Luan
authors.forename: Russell
authors.initials: R
authors.lastname: Localio
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.forename: Lisa
authors.initials: L
authors.lastname: McLeod
authors.forename: Dingwei
authors.initials: D
authors.lastname: Dai
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
mesh_terms: D002648:Child; D015331:Cohort Studies; D057186:Comparative Effectiveness Research / Q000191:economics / Q000379:methods*; D006292:Health Priorities / Q000191:economics / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015233:Models, Statistical; D010372:Pediatrics / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics / Q000706:statistics & numerical data; D014481:United States