PEDIATRIC CRITICAL CARE AND HOSPITAL COSTS UNDER REIMBURSEMENT BY DIAGNOSIS-RELATED GROUP - EFFECT OF CLINICAL AND DEMOGRAPHIC CHARACTERISTICS

Objective: To determine the relationship of demographic and clinical v ariables to cost, to revenue based on diagnosis-related groups, and to profit in patients in a pediatric intensive core unit (PICU). Design: Prospective collection of clinical and demographic data of patients s ampled. Detailed financial data for all patients discharged from the h ospital were compiled by the office of financial planning. A combined data set was used for analysis. Setting: A mulildisciplinary PICU with in a general, tertiary-care, teaching hospital in on urban environment . Patients: Consecutive sample of 1174 pediatric patients discharged f rom the PICU during a 24-month period. Measurements and main results: Hospital cost (not charges) determined according to industry standards . Revenue was determined by the DRG system. Of the 1174 cases identifi ed, DRG coding and financial data were 97% complete. The mean loss (ne gative profit) per patient was $9218 +/- $33,676. Profit was significa ntly and adversely affected by outlier status, death, high risk of dea th, interhospital transfer, emergency admission, young age, and mechan ical ventilation. Multivariate analysis revealed that duration of stay , death, interhospital transfer, oad age negatively correlated with pr ofit. Conclusion: Under a DRG-based reimbursement system, the operatio n of an active PICU with a broad referral bose may not be desirable fr om a financial perspective. Similar studies at other institutions coul d help establish a data base with which the DRG system con be refined.