title: Is hospital teaching status a key factor in hospital charge for children with hip fractures?: preliminary findings from KID database.
abstract: OBJECTIVE
  Proximal femur fractures cause significant pain and economic cost among pediatric patients. The purposes of this study were (a) to evaluate the distribution by hospital type (teaching hospital vs non-teaching hospital) of U.S. pediatric patients aged 1-20 years who were hospitalized with a closed hip fracture and (b) to discern the mean hospital charge and hospital length of stay after employing propensity score to reduce selection bias.
  
  
  METHODS
  The 2006 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was queried for children aged up to 20 years that had principle diagnosis of hip fracture injury. Hip fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820.0, 820.2 and 820.8 under Section "Injury and Poisoning (800-999)" with principle internal fixation procedure codes 78.55, 79.15 and 79.35. Patient demographics and hospital status were presented and analyzed. Differences in mean hospital charge and hospital length of stay by hospital teaching status were assessed via two propensity score based methods.
  
  
  RESULTS
  In total, 1,827 patients were nation-ally included for analysis: 1,392 (76.2%) were treated at a teaching hospital and 435 (23.8%) were treated at a non-teaching hospital. The average age of the patients was 12.88 years old in teaching hospitals vs 14.33 years old in nonteaching hospitals. The propensity score based adjustment method showed mean hospital charge was $34,779 in teaching hospitals and $32,891 in the non-teaching hospitals, but these differences were not significant (p=0.2940). Likewise, mean length of hospital stay was 4.1 days in teaching hospitals and 3.89 days in non-teaching hospitals, but these differences were also not significant (p=0.4220).
  
  
  CONCLUSIONS
  Hospital teaching status did not affect length of stay or total hospital costs in children treated surgically for proximal femur fractures. Future research should be directed at identifying factors associated with variations in hospital charge and length of stay.
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.forename: Andrew
authors.initials: A
authors.lastname: Pugely
authors.forename: Matthew
authors.initials: M
authors.lastname: Karam
authors.forename: Phinit
authors.initials: P
authors.lastname: Phisitkul
authors.forename: Sergio
authors.initials: S
authors.lastname: Mendoza
authors.forename: Richard C
authors.initials: RC
authors.lastname: Johnston
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D059019:Clinical Coding; D016208:Databases, Factual; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics*; D017048:Health Care Costs; D006620:Hip Fractures / Q000191:economics* / Q000628:therapy; D017722:Hospital Charges; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
references.citation: Ann Acad Med Singap. 2002 Jan;31(1):3-7
references.pmid: 11885492
references.citation: Arch Intern Med. 2003 Nov 24;163(21):2576-82
references.pmid: 14638557
references.citation: Res Q Exerc Sport. 1994 Dec;65(4):347-54
references.pmid: 7886284
references.citation: J Bone Joint Surg Am. 2012 Jan 4;94(1):9-17
references.pmid: 22218377
references.citation: Mayo Clin Proc. 1993 Oct;68(10):939-47
references.pmid: 8412359
references.citation: Pharmacoepidemiol Drug Saf. 2004 Dec;13(12):855-7
references.pmid: 15386710
references.citation: Mayo Clin Proc. 1990 Jan;65(1):38-50
references.pmid: 2296211
references.citation: Ambul Pediatr. 2006 Jan-Feb;6(1):15-20
references.pmid: 16443178
references.citation: J Trauma. 2000 Aug;49(2):237-45
references.pmid: 10963534
references.citation: Am J Ophthalmol. 2010 Jan;149(1):7-9
references.pmid: 20103037
references.citation: J Pediatr Surg. 1990 Jan;25(1):85-90; discussion 90-1
references.pmid: 2299550
references.citation: JAMA. 2003 Dec 24;290(24):3207-14
references.pmid: 14693873
references.citation: Ann Thorac Surg. 2003 Dec;76(6):2000-6
references.pmid: 14667630
references.citation: Stat Med. 1998 Oct 15;17(19):2265-81
references.pmid: 9802183
references.citation: J Pediatr Orthop. 2009 Jul-Aug;29(5):435-8
references.pmid: 19568012
references.citation: Iowa Orthop J. 2010;30:115-8
references.pmid: 21045983
references.citation: J Pediatr Orthop. 2001 Jul-Aug;21(4):436-41
references.pmid: 11433152
references.citation: J Pediatr Orthop. 2005 Jan-Feb;25(1):39-44
references.pmid: 15614057
references.citation: J Pediatr Orthop. 1999 Mar-Apr;19(2):222-8
references.pmid: 10088693
references.citation: Future Child. 2000 Spring-Summer;10(1):137-63
references.pmid: 10911691
references.citation: Arch Pediatr Adolesc Med. 2007 Sep;161(9):889-95
references.pmid: 17768290
references.citation: Ophthalmology. 2006 Aug;113(8):1264-70
references.pmid: 16877067