Costs for DKA care vary significantly among U.S. hospitals

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1. Hospital costs, length of stay, and readmission rates for diabetic ketoacidosis (DKA) vary widely across United States children’s hospitals.

2. The mean hospital-level total standardized cost differs by as much as ~$8,000 across hospitals, while the absolute one-year readmission rate differs by as much as 34%.

Evidence Rating Level: 2 (Good)           

Study Rundown: Diabetic ketoacidosis (DKA) is a common, potentially deadly, but preventable complication of Type 1 diabetes mellitus (DM1). It is also the most common reason for hospitalization of DM1 patients and contributes significantly to hospital costs. Results from the current study indicate significant variations in hospital resource utilization as characterized by hospital costs, which suggests possible inconsistencies in DKA care. Bed utilization costs, specifically days spent in non-ICU beds, made up the greatest proportion of the total mean standardized cost. Significant variation also occurred in length of stay (LOS) and one-year readmission rates for DKA. This study was limited by use of administrative data rather than clinical data and the grouping of all DM1 patients together, regardless of whether or not the current DKA episode was the first time diagnosis of DM1. Nonetheless, these results suggest that best practices and benchmarking can lead to decreased resource utilization in DKA management.

Click to read the study, published today in Pediatrics

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In-Depth [retrospective cohort study]: This six-year study examined data from a total of 24,890 children from 38 U.S. children’s hospitals who were discharged with a diagnosis of DKA. The mean patient age was 11.6 years. Resource use was characterized by the costs of patients’ total clinical transaction codes for DKA care. The mean total hospital-level cost was $7,142 per patient and ranged from $4,125 to $11,916 across hospitals. The non-ICU portion of the hospitalization accounted for the majority of the total standardized cost per hospitalization. Mean LOS (2.4 days) and mean non-ICU LOS (1.9 days) varied widely across hospitals (1.5-3.7 and 0.7-2.7, respectively). The variation in costs for non-ICU bed days (0.34) and clinical therapies (0.57) was significantly greater than laboratory (0.07) and imaging (0.08) costs. Furthermore, 20.3% of encounters were readmissions at one year, which also varied significantly across hospitals (6.5%-41.1%).

By Cordelia Y. Ross and Leah H. Carr

Reviewed by William V. Raszka, MD

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