title: Practice Patterns in Medicaid and Non-Medicaid Asthma Admissions.
abstract: With American children experiencing increased Medicaid coverage, it has become especially important to determine if practice patterns differ between Medicaid and non-Medicaid patients. Auditing such potential differences must carefully compare like patients to avoid falsely identifying suspicious practice patterns. We asked if we could observe differences in practice patterns between Medicaid and non-Medicaid patients admitted for asthma inside major children's hospitals.
  
  
  
  A matched cohort design, studying 17 739 matched pairs of children (Medicaid to non-Medicaid) admitted for asthma in the same hospital between April 1, 2011 and March 31, 2014 in 40 Children's Hospital Association hospitals contributing data to the Pediatric Hospital Information System database. Patients were matched on age, sex, asthma severity, and other patient characteristics.
  
  
  
  Medicaid patient median cost was $4263 versus $4160 for non-Medicaid patients (P < .001). Additionally, the median cost difference (Medicaid minus non-Medicaid) between individual pairs was only $84 (95% confidence interval: 44 to 124), and the mean cost difference was only $49 (95% confidence interval: -72 to 170). The 90th percentile costs were also similar between groups ($10 710 vs $10 948; P < .07). Length of stay (LOS) was also very similar; both groups had a median stay of 1 day, with a similar percentage of patients exceeding the 90th percentile of individual hospital LOS (7.1% vs 6.7%; P = .14). ICU use was also similar (10.1% vs 10.6%; P = .12).
  
  
  
  For closely matched patients within the same hospital, Medicaid status did not importantly influence costs, LOS, or ICU use.
authors.affiliation: Center for Outcomes Research, Departments of Pediatrics, and Anesthesiology and Critical Care, Perelman School of Medicine, Departments of Health Care Management, and Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA silber@email.chop.edu.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Silber
authors.affiliation: Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA Statistics, The Wharton School, and.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Rosenbaum
authors.affiliation: Center for Outcomes Research.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Center for Outcomes Research.
authors.forename: Shawna
authors.initials: S
authors.lastname: Calhoun
authors.affiliation: Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA Divisions of General Pediatrics, and.
authors.forename: James P
authors.initials: JP
authors.lastname: Guevara
authors.affiliation: Departments of Pediatrics, and Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia PA;
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Zorc
authors.affiliation: Center for Outcomes Research.
authors.forename: Orit
authors.initials: O
authors.lastname: Even-Shoshan
mesh_terms: D001249:Asthma / Q000191:economics / Q000628:therapy*; D002648:Child; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D010818:Practice Patterns, Physicians'; D012107:Research Design; D014481:United States