PhD Candidate University of Kentucky College of Pharmacy Lexington, Kentucky, United States
Background: While survival of preterm infants has improved in the United States, the risk of long-term lung disease prevalence in this population remains high. Understanding regional patterns in neonatal lung disease could lead to improved prevention and care strategies. The burden is seen with admission, stay, and cost. These factors attribute to birth complications, gestational age, mother co-morbidities, mechanical ventilation, infection rates, and medication usage. Objective: Using Medicaid claims can work to identify patterns of relevance associated to preterm infant cost and admission. Patterns of neonatal respiratory and pulmonary disease, in the state of Kentucky, are observed with a goal of better defining patient characteristics, neonatal care, and related medical costs for birth during the years 2017-2019. Design/Methods: De-identified patient records and Medicaid claims were acquired by a state-funded program and ICD-10 codes related to pulmonary status were investigated: Respiratory Distress Syndrome, RDS P22.X; Bronchopulmonary Dysplasia, BPD P28.5; Perinatal Chronic Respiratory Distress, PCRD P27.X. A total of 8 million individual Medicaid claims, including the birth outcomes and postnatal medical care for 104,000 infants, were studied. Retrospective data analytics methodologies over the first 2yrs of life were investigated. Trends from 2017 to 2019 were studied along with regional distribution of patient and care. Continuous variables were compared using T-tests or ANOVA, where appropriate. Categorical variables were compared using Pearson Chi-square or Fisher’s Exact tests as appropriate; p< 0.05 was considered significant. Results: Overall incidence of each pulmonary diagnosis was: RDS, 10.7%; BPD, 2.9%; PCRD, 1.1% of total live births. Each pulmonary diagnosis was inversely related to gestational age at birth. Cases of BPD were 2-fold greater in total healthcare costs over the first 180 days (p < 0.05). Early life ( < 180 days) healthcare costs were highest for cases of PCRD (on avg $70,000 versus $300,000, respectively). Males less than 28 weeks gestational age at birth had significantly higher medical costs than females, but similar incidence of pulmonary diagnoses. There were no geographic patterns identified.
Conclusion(s): These findings demonstrate Medicaid claims can illustrate patient care patterns and related costs for neonates and that pulmonary morbidities are significant contributors to hospitalization costs in this population. This analytical approach using available data may be useful for enhanced opportunities in perinatal care.
