Year of Publication

2019

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Sarah Wackerbarth

Committee Member

Dr. Paula Arnett

Committee Member

Dr. Erich Maul

Abstract

Introduction

A comprehensive respiratory panel (CRP) is a quick and non-invasive laboratory diagnostic test that can detect viral nucleic acids by utilizing polymerase chain reactions (PCR). A CRP can detect multiple causative agents associated with upper respiratory illness and CRPs are commonly used in the Kentucky Children’s Hospital as part of the initial evaluation for patients who present with signs and symptoms of a respiratory infection. While CRPs are quick to detect the presence of a viral illness and are shown to increase the prescribing of antivirals for viral illnesses, the cost of the CRP to the hospital is around $130, and the cost to patients is even more. There is no published literature that analyzes the cost of CRPs when considering the price of the test, the change in length of stay, and the potential cost savings of antibiotic discontinuations related to positive PCR results.

Methods

The study was a chart review of pediatric patients, one day to 18 years old, who received a comprehensive respiratory panel diagnostic test for a suspected respiratory illness while admitted to the Kentucky Children’s Hospital (KCH) between October 1, 2016 and April 30, 2018. Patients were identified via ICD-9 or ICD-10 codes for respiratory illness during the study time frame. Other data that were collected include antibiotic use, length of stay, and comprehensive respiratory panel results. The cost analysis was completed by comparing the cost and use of the CRP to the direct, indirect and total costs of hospitalization.

Results

A total of 355 patients comprised the study population. Only 20.2% (N=72) of patients received a CRP and of those CRPs 75% (N=54) were positive for viral analytes. The median total cost of admission for the study population was $3,623.07. Patients with a CRP had significantly higher direct, indirect, and total costs (p<0.05). The median length of stay (two days) was the same in those with or without CRPs.

Conclusions

Overall, patients admitted to KCH who received CRPs had greater costs than those who did not. Furthermore, there was no significant difference in the median length of stay between those with or without CRPs. The study shows ways that healthcare costs can be diminished through policy development and public health initiatives around culture stewardship.

Available for download on Saturday, July 25, 2020

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