Time to send the preemie home? Additional maturity at discharge and subsequent health care costs and outcomes

Health Serv Res. 2009 Apr;44(2 Pt 1):444-63. doi: 10.1111/j.1475-6773.2008.00938.x. Epub 2008 Dec 31.


Objective: To determine whether longer stays of premature infants allowing for increased physical maturity result in subsequent postdischarge cost savings that help counterbalance increased inpatient costs.

Data sources: One thousand four hundred and two premature infants born in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2002.

Study design/methods: Using multivariate matching with a time-dependent propensity score we matched 701 "Early" babies to 701 "Late" babies (developmentally similar at the time the earlier baby was sent home but who were discharged on average 3 days later) and assessed subsequent costs and clinical outcomes.

Principal findings: Late babies accrued inpatient costs after the Early baby was already home, yet costs after discharge through 6 months were virtually identical across groups, as were clinical outcomes. Overall, after the Early baby went home, the Late-Early cost difference was $5,016 (p<.0001). A sensitivity analysis suggests our conclusions would not easily be altered by failure to match on some unmeasured covariate.

Conclusions: In a large integrated health care system, if a baby is ready for discharge (as defined by the typical criteria), staying longer increased inpatient costs but did not reduce postdischarge costs nor improve postdischarge clinical outcomes.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Algorithms
  • California
  • Cost Savings
  • Costs and Cost Analysis
  • Health Expenditures*
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Length of Stay* / economics
  • Outcome Assessment, Health Care / economics
  • Patient Discharge / economics*