Effects of health care cost-containment programs on patterns of care and readmissions among children and adolescents

Objectives. This study examined the effects of a utilization management pro gram on patterns of medical care among children and adolescents. Methods. From 1989 through 1993, the program conducted 8568 reviews Of pedi atric patients, ranging in age from birth to 18 years. The program used pre admission and concurrent review procedures to review and certify patients' need for care. This study used multivariate analyses to assess changes in t he number of days of inpatient care approved by the program and to determin e whether limitations imposed on length of stay affected the risk of 60-day readmission. Results. Concurrent review reduced the number of requested days of inpatien t care by 3.2 days per patient, Low-birthweight infants and adolescent pati ents with depression or alcohol or drug dependence accounted for a dispropo rtionate share of the reduction. Patients classified as admitted for medica l or mental health care and whose stay was restricted by concurrent review were more likely (P < .05) to be readmitted within 60 days after discharge. Conclusions. By limiting care through its review procedures, the utilizatio n management program decreased inpatient resource consumption but also incr eased the risk of readmission for some patients. Continued investigation sh ould be conducted of the effects of cost-containment programs on the qualit y of care given to children and adolescents. especially in the area of ment al health.