Abstract

Healthcare equity remains a national political debate with 15% or 27.4 million non-elderly Americans still uninsured in 2017 compared to other developed countries which have almost 100% universal coverage.

Purpose: The goal of this study is to evaluate post-neo-natal healthcare, with a focus on secondary care and social determinants as some of the factors involved in healthcare inequities for socioeconomically disadvantaged families. The objective is to investigate hospitalization for infants and some of the demographics affecting inpatients in order to identify high risk populations and improve medical outcomes in post-neo-natal health. The hypothesis is to determine whether primary diagnoses, length of stay, hospital outcomes or patient disposition, and total charges of post-neo-natal admissions differ with geographic regions, income bracket, and insurance type in the United States.

Method: A Cross-Sectional Study was conducted with a population of 871845 inpatients for the years 2012-2014 with infants 28-364 days old using Hospital Cost and Utilization Project National Inpatient Sample (HCUP-NIS) data from the National Institute of Health (NIH) with length of stay and total charges as dependent variables and various components used as independent variables.

Results: These results show that infants 28-364 days old in 2012, 2013, 2014 showed utilization of hospitals for care that may be classified as routine 92.7% of the time. 75% were with low risk of dying, 45% with minor loss of function, over 96% were not under major substances of abuse, 58% did not require any procedures, 53% did not have chronic morbidities, and 45% were not even eligible for emergency room billing. The total charges accrued were paid for by Medicaid as primary payer 64% of the time, and private insurance 30% of the time. Over a third (37%) of inpatients came from the lowest household median income in the country (0- 25000 zip quartile income percentile) and quarters (25%) were of the next level (25-60000 zip quartile income). Regional dynamics accounted for variations in mean total charges of $27,704.45 in the East South Central region to $61,911.58 in the Pacific per length of stay (LOS). The mean LOS was 4.72 days and sum total charges nationally were $34,727,880,784.

Conclusion: A Learning Health System is necessary to continuously identify the root cause analysis of hospitalization and link infant postnatal care with maternal postpartum care. Patients need to be identified- stratified-triaged upon admission and redirected back to primary care if appropriate to reduce unnecessary hospitalizations and emergency visits. This could significantly move this discipline forward. There needs to be optimized transition of care post discharge to avoid readmissions, encourage routine scheduled well-visits.