title: Pediatric versus adult cardiomyopathy and heart failure-related hospitalizations: a value-based analysis.
abstract: BACKGROUND
  Value-based health care is a proposed driver for reimbursement under the Affordable Care Act, with value broadly defined as outcomes divided by cost. Data on value-based health care in pediatric heart failure are scarce.
  
  
  RESULTS
  A retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database and Nationwide Inpatient Sample was performed for pediatric and adult cardiomyopathy and heart failure-related hospitalizations. The study included 5,689 pediatric and 473,416 adult hospitalizations. Pediatric cardiomyopathy and heart failure hospitalizations were significantly longer than adult hospitalizations (mean ± SE 16.2 ± 0.7 days vs 6.8 ± 0.1 days; P < .001). Overall mortality was greater for pediatric hospitalizations (7.7% vs 5.6%; P < .001), although it decreased over time for both pediatric and adult hospitalizations. Charges were greater for pediatric hospitalizations, both overall ($116,483 ± $5,735 vs $40,662 ± $1,419; P < .001) and for all years evaluated.
  
  
  CONCLUSIONS
  In a value-based model, pediatric cardiomyopathy and heart failure-related hospitalizations are associated with worse outcomes and greater charges than adult hospitalizations. More research is needed to understand the cost effectiveness of pediatric heart failure treatment and to reduce the burden on the health care system.
authors.affiliation: Department of Pediatrics, University of Rochester Medical Center, Rochester, New York.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Wittlieb-Weber
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Kimberly Y
authors.initials: KY
authors.lastname: Lin
authors.affiliation: Department of Pediatric Infectious Disease, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: O'Connor
authors.affiliation: Weststat, Houston, Texas.
authors.forename: Ken
authors.initials: K
authors.lastname: Gerald
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Paridon
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Shaddy
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: rossanoj@email.chop.edu.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006333:Heart Failure / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D006760:Hospitalization / Q000191:economics* / Q000639:trends; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000639:trends; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D062505:Value-Based Purchasing / Q000191:economics* / Q000639:trends; D055815:Young Adult
keywords: Heart failure; cardiomyopathy; outcomes