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Resource utilisation in paediatric patients with secundum atrial septal defects

Published online by Cambridge University Press:  10 February 2020

Daniel S. Ziebell*
Affiliation:
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Stephanie Ghaleb
Affiliation:
Cincinnati Children’s Medical Center, The Heart Institute, Cincinnati, OH, USA
Jeffrey Anderson
Affiliation:
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA Cincinnati Children’s Medical Center, The Heart Institute, Cincinnati, OH, USA
Christopher J. Statile
Affiliation:
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA Cincinnati Children’s Medical Center, The Heart Institute, Cincinnati, OH, USA
*
Author for correspondence: D. Ziebell, MD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH45229, USA. Tel: +1 262 617 4880; Fax: +1 404 785 9188; Email: dan.ziebell@gmail.com

Abstract

Background:

There is variation in care of secundum atrial septal defects. Defects <3 mm and patent foramen ovale are not clinically significant. Defects >3 mm are often followed clinically and may require closure. Variation in how these lesions are monitored may result in over-utilisation of routine studies and higher than necessary patient charges.

Purpose:

To determine utilisation patterns for patients with secundum atrial septal defects diagnosed within the first year of life and compare to locally developed optimal utilisation standard to assess charge savings.

Methods:

This was a retrospective chart review of patients with secundum atrial septal defects diagnosed within the first year of life. Patients with co-existing cardiac lesions were excluded. Total number of clinic visits, electrocardiograms, and echocardiograms were recorded. Total charge was calculated based on our standard institutional charges. Patients were stratified based on lesion and provider type and then compared to “optimal utilisation” using analysis of variance statistical analysis.

Results:

Ninety-seven patients were included, 40 had patent foramen ovale (or atrial septal defect <3 mm), 43 had atrial septal defects not requiring intervention and 14 had atrial septal defects requiring intervention. There was a statistically significant difference in mean charge above optimal for these lesions of $1033, $2885, and $5722 (p < 0.02), respectively. There was statistically significant variation of charge among types of provider as well. Average charge savings per patient would be $2530 with total charge savings of $242,472 if the optimal utilisation pathway was followed.

Conclusion:

Using optimal utilisation and decreasing variation could save the patient significant unnecessary charges.

Type
Original Article
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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