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1 Supplemental Digital Content
Table of Contents
Supplemental Digital Appendix 1: Variable Direct Costs of Utilization Categories ...2-3 Supplemental Digital Appendix 2: Frequencies of Utilization Categories ...4-6 Supplemental Digital Appendix 3: Univariate Linear Regression Estimates Quantifying the Association Between Log-Transformed Variable Direct Cost, Length of Stay, Service, and Other Patient and Admission Characteristics
...7-9
Supplemental Digital Appendix 4: Multivariable Linear Regression Estimates Quantifying the
Association Between Log-Transformed Variable Direct Cost, Length of Stay, and Service While
Accounting for Patient and Admission Characteristics and the Propensity Score Adjustment
...10-13
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2 Supplemental Digital Appendix 1
Variable Direct Costs of Utilization Categories
Variable
Resident Median (IQR)
Non-Resident Median (IQR)
Pharmacy 180 (0,6736) 183 (0,5322) Labs Clinical 176 (0,1562) 182 (0,1530) Nursing Unit 1105 (0,4616) 1149 (183,5786) Operating Room 0 (0,5311) 0 (0,5150) Radiology Diagnostic 138 (0,1372) 136 (0,1207) Phys/Occ Therapy 0 (0,568) 90 (0,655) Emergency 341 (0,1224) 341 (0,1333) Blood Service 0 (0,2730) 0 (0,2131) Other Cardiac Service 4 (0,234) 3 (0,215) ICU Nursing Unit 0 (0,9756) 0 (0,7604) Cardiac Cath Lab 0 (0,1278) 0 (0,1110) Radiology Special 0 (0,3675) 0 (0,3308)
GI Labs 0 (0,3474) 0 (0,2186)
Resp/Pulm Service 0 (0,664) 0 (0,606)
Cardiac EP Lab 0 (0,0) 0 (0,0)
Specialty Practices 0 (0,456) 0 (0,477)
Anesthesia 0 (0,562) 0 (0,562)
Dialysis/Renal 0 (0,1127) 0 (0,1210)
Other 0 (0,790) 0 (0,790)
Primary Care Practices 0 (0,46) 0 (0,39)
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3
Oncology 0 (0,0) 0 (0,0)
Radiation Therapy 0 (0,0) 0 (0,0) Medical Practices 0 (0,0) 0 (0,0)
Transplant 0 (0,0) 0 (0,0)
Nutrition 0 (0,0) 0 (0,0)
Not Categorized 0 (0,0) 0 (0,0)
Pediatric Practices 0 (0,0) 0 (0,0)
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4 Supplemental Digital Appendix 2
Frequencies of Utilization Categories
Variable
Resident Median (IQR)
Non-Resident Median (IQR)
Lab 44 (21,113) 42 (19,112)
Nursing 12 (6,26) 12 (6,26)
Microbiology 4 (0,18) 5 (0,18)
Imaging 4 (1,11) 4 (1,11)
Discharge 5 (4,10) 5 (4,8)
Point of Care Testing 1 (0,8) 1 (0,10)
Diet 2 (1,6) 2 (1,6)
Consult 2 (0,6) 2 (0,7)
Core Measures 2 (1,4) 2 (1,4)
ECG 1 (0,4) 1 (0,4)
Blood Bank 0 (0,4) 0 (0,3)
ADT Patient Update 2 (1,3) 2 (1,3)
Code Status 1 (1,3) 1 (1,3)
Respiratory Care 0 (0,3) 0 (0,3)
IV 1 (0,3) 1 (0,3)
Transfer 1 (1,2) 1 (1,2)
PT 1 (0,2) 1 (0,2)
Cardiac Services 0 (0,1) 0 (0,1)
Outpatient Referral 0 (0,2) 0 (0,2)
Isolation 0 (0,1) 0 (0,2)
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Nursing Transfusion 0 (0,1) 0 (0,1)
Pathology and Cytology 0 (0,2) 0 (0,2)
Nourishments 0 (0,1) 0 (0,1)
Vascular 0 (0,1) 0 (0,1)
Case Request 0 (0,1) 0 (0,1)
Restraints 0 (0,0) 0 (0,0)
Procedures 0 (0,1) 0 (0,1)
Dialysis Apheresis 0 (0,0) 0 (0,0)
Precaution 0 (0,1) 0 (0,1)
SLP 0 (0,1) 0 (0,1)
Cardiac Cath 0 (0,0) 0 (0,0)
OT 0 (0,1) 0 (0,1)
GI 0 (0,1) 0 (0,1)
Behavioral Health Services 0 (0,8) 0 (0,0)
Wound Ostomy 0 (0,0) 0 (0,1)
Neurology 0 (0,0) 0 (0,0)
Substance Abuse 0 (0,0) 0 (0,0)
Electrophysiology 0 (0,0) 0 (0,0)
Nuclear Cardiology 0 (0,0) 0 (0,0)
PFT 0 (0,0) 0 (0,0)
General Supply 0 (0,0) 0 (0,0)
Legal 0 (0,0) 0 (0,0)
Surgical Blood 0 (0,0) 0 (0,0)
Echocardiography 0 (0,0) 0 (0,0)
Cast Clinic 0 (0,0) 0 (0,0)
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OB 0 (0,0) 0 (0,0)
Privilege Level 0 (0,0) 0 (0,0)
PR Charge 0 (0,0) 0 (0,0)
Card Rehab 0 (0,0) 0 (0,0)
ENT 0 (0,0) 0 (0,0)
Immunization Injection 0 (0,0) 0 (0,0)
E Consult 0 (0,0) 0 (0,0)
Sleep Center 0 (0,0) 0 (0,0)
Transport 0 (0,0) 0 (0,0)
Ophthalmology 0 (0,0) 0 (0,0)
GU Procedure 0 (0,0) 0 (0,0)
Cardiac Stress 0 (0,0) 0 (0,0)
Cardiac Monitors 0 (0,0) 0 (0,0)
Patient Gateway Flowsheet 0 (0,0) 0 (0,0)
Audiology 0 (0,0) 0 (0,0)
Point of Care Testing Docked Device 0 (0,0) 0 (0,0)
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7 Supplemental Digital Appendix 3
Univariate Linear Regression Estimates Quantifying the Association Between Log- Transformed Variable Direct Cost, Length of Stay, Service, and Other Patient and Admission Characteristics
Variable Direct Cost, $ Length of Stay, days
Estimate 95% CI P Estimate 95% CI P
Service
Resident Service (Reference) 4303 4176 4434 4.57 4.44 4.70 Non-Resident Service 1.10 1.05 1.16 < .001 1.09 1.04 1.14 < .001
Sex
Female (Reference) 4547 4393 4706 4.82 4.66 4.98
Male 0.97 0.93 1.02 0.25 0.97 0.92 1.01 0.15
Age
18 to 34 (Reference) 3623 3380 3883 3.79 3.54 4.05
35 to 49 1.14 1.04 1.25 < .01 1.18 1.08 1.29 < .001
50 to 64 1.25 1.15 1.36 < .001 1.23 1.14 1.33 < .001 65 to 74 1.34 1.23 1.47 < .001 1.34 1.23 1.46 < .001 75 to 84 1.37 1.25 1.50 < .001 1.39 1.28 1.52 < .001 85 and Above 1.21 1.10 1.33 < .001 1.27 1.16 1.40 < .001
Race
White (Reference) 4531 4414 4650 4.75 4.63 4.87
Black 1.01 0.93 1.10 0.77 1.07 0.98 1.16 0.12
Asian 0.89 0.77 1.02 0.09 0.87 0.76 1.00 0.05
Hispanic/Latino 0.90 0.72 1.11 0.31 0.93 0.75 1.14 0.46
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Other Races 0.90 0.82 0.99 0.03 0.93 0.85 1.02 0.12
Payer
Medicare (Reference) 4810 4664 4959 5.05 4.90 5.20
Medicaid 0.87 0.82 0.93 < .001 0.93 0.88 0.99 0.02
Private 0.84 0.80 0.89 < .001 0.81 0.77 0.86 < .001
Other 0.73 0.61 0.87 < .001 0.77 0.65 0.92 < .01
Acuity
MS-DRG 0 to 1 (Reference) 3022 2936 3110 3.45 3.35 3.55
MS-DRG 1 to 2 1.80 1.72 1.88 < .001 1.65 1.58 1.72 < .001 MS-DRG 2 to 4 3.35 3.09 3.62 < .001 2.36 2.17 2.56 < .001 MS-DRG 4+ 6.72 5.96 7.57 < .001 3.97 3.51 4.50 < .001
Length of Stay
0 to 4 (Reference) 2388 2344 2433
5 to 9 2.22 2.15 2.28 < .001
10 to 19 5.10 4.91 5.30 < .001
20 and Above 13.20 12.42 14.04 < .001
Propensity Score
Decile 1 4286 3984 4611 4.77 4.44 5.12
Decile 2 1.08 0.97 1.20 0.15 1.03 0.93 1.13 0.61
Decile 3 1.08 0.97 1.20 0.16 1.01 0.92 1.12 0.81
Decile 4 1.16 1.05 1.29 < .01 1.03 0.93 1.14 0.55
Decile 5 1.12 1.02 1.25 0.03 1.04 0.94 1.15 0.43
Decile 6 1.07 0.96 1.18 0.23 0.99 0.90 1.10 0.91
Decile 7 1.05 0.94 1.16 0.40 0.99 0.90 1.10 0.87
Decile 8 1.02 0.92 1.13 0.69 0.99 0.89 1.09 0.77
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9
Decile 9 0.94 0.84 1.04 0.21 0.90 0.81 1.00 0.04
Decile 10 0.96 0.87 1.06 0.44 0.94 0.85 1.04 0.21
Admitting Diagnosis
Circulatory system
(reference)
4321 4087 4569 4.84 4.58 5.11Digestive system
0.92 0.85 1.00 .05 0.84 0.78 0.91 <.001Genitourinary system
0.85 0.76 0.94 <.01 0.87 0.78 0.97 .01Musculoskeletal system
and connective tissue
1.27 1.11 1.46 .001 1.07 0.94 1.22 .33Respiratory system
0.98 0.90 1.07 .67 0.96 0.88 1.04 .27Skin and subcutaneous
tissue
0.89 0.77 1.01 .08 0.90 0.79 1.03 .13Endocrine, nutritional, or metabolic diseases and immunity
disorders
0.94 0.83 1.06 .28 0.96 0.86 1.08 .53Infectious and parasitic
diseases
1.64 1.49 1.80 <.001 1.42 1.29 1.56 <.001Injury and poisoning
1.33 1.21 1.47 <.001 1.08 0.98 1.18 .13Mental illness
0.89 0.81 0.97 .01 0.89 0.82 0.98 .02Other admitting diagnosis
1.05 0.96 1.14 .31 0.95 0.87 1.03 .21*All estimates of Variable Direct Cost analysis have been rounded to the nearest dollar
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction is prohibited.
10 Supplemental Digital Appendix 4
Multivariable Linear Regression Estimates Quantifying the Association Between Log- Transformed Variable Direct Cost, Length of Stay, and Service While Accounting for Patient and Admission Characteristics and the Propensity Score Adjustment
Variable Direct Cost, $ Length of Stay, days
Estimate 95% CI P Estimate 95% CI P
Intercept 1861 1588 2182 3.62 2.76 4.75
Service
Resident Service (Reference)
Non-Resident Service 1.03 1.01 1.06 0.01 1.10 1.05 1.14
<
.001
Sex
Female (Reference)
Male 0.99 0.93 1.06 0.87 0.86 0.77 0.97 0.01
Age
18 to 34 (Reference)
35 to 49 1.04 0.99 1.09 0.11 1.12 1.03 1.22 0.01
50 to 64 1.06 1.00 1.12 0.03 1.07 0.98 1.18 0.15
65 to 74 1.06 1.00 1.12 0.04 1.16 1.05 1.27 < .01
75 to 84 1.04 0.99 1.10 0.15 1.26 1.15 1.38
<
.001
85 and Above 1.02 0.96 1.08 0.49 1.20 1.09 1.33
<
.001
Race
White (Reference)
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11
Black 0.98 0.93 1.02 0.28 1.06 0.98 1.14 0.17
Asian 0.97 0.89 1.06 0.50 0.92 0.80 1.07 0.29
Hispanic/Latino 1.03 0.90 1.18 0.66 0.93 0.74 1.18 0.56
Other Races 0.99 0.94 1.04 0.64 0.99 0.91 1.09 0.91
Payer
Medicare (Reference)
Medicaid 1.01 0.92 1.11 0.88 0.96 0.81 1.12 0.58
Private 1.03 0.98 1.07 0.22 0.90 0.83 0.97 0.01
Other 1.00 0.86 1.16 > .99 0.81 0.63 1.05 0.11
Acuity
MS-DRG 0 to 1 (Reference)
MS-DRG 1 to 2 1.23 1.20 1.27
<
.001 1.56 1.48 1.64
<
.001
MS-DRG 2 to 4 1.65 1.57 1.74
<
.001 2.34 2.15 2.54
<
.001
MS-DRG 4+ 2.08 1.91 2.27
<
.001 3.59 3.11 4.16
<
.001
Length of Stay
0 to 4 (Reference)
5 to 9 2.07 2.02 2.13
<
.001
10 to 19 4.29 4.13 4.45
<
.001
20 and Above 10.01 9.42 10.65
<
.001
Propensity Score
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12
Decile 1
Decile 2 1.04 0.96 1.12 0.33 0.96 0.84 1.09 0.54
Decile 3 1.05 0.95 1.15 0.36 0.92 0.78 1.08 0.33
Decile 4 1.08 0.96 1.21 0.19 0.88 0.72 1.06 0.19
Decile 5 1.10 0.96 1.25 0.17 0.90 0.72 1.13 0.37
Decile 6 1.07 0.92 1.24 0.36 0.84 0.65 1.08 0.17
Decile 7 1.06 0.90 1.26 0.48 0.83 0.62 1.10 0.20
Decile 8 1.07 0.88 1.29 0.51 0.82 0.59 1.13 0.23
Decile 9 1.09 0.88 1.35 0.42 0.72 0.50 1.04 0.08
Decile 10 1.10 0.84 1.42 0.49 0.67 0.43 1.06 0.09
Admitting Diagnosis
Circulatory system
Digestive system
1.08 1.00 1.16 .05 1.03 0.91 1.17 .63Genitourinary system
1.03 0.91 1.17 .61 1.18 0.95 1.46 .13Musculoskeletal system
and connective tissue
1.04 0.90 1.20 .62 1.22 0.95 1.55 .12Respiratory system
1.02 0.88 1.17 .82 1.18 0.93 1.50 .18Skin and subcutaneous
tissue
0.98 0.83 1.17 .86 1.36 1.02 1.83 .04Endocrine, nutritional, or metabolic diseases and immunity
disorders
0.98 0.90 1.08 .72 1.13 0.96 1.31 .13Infectious and parasitic
diseases
1.11 1.04 1.18 .001 1.24 1.11 1.38 <.001Copyright © by the Association of American Medical Colleges. Unauthorized reproduction is prohibited.
13
Injury and poisoning
1.16 1.08 1.25 <.001 1.08 0.95 1.23 .25Mental illness
1.06 1.00 1.12 .06 1.11 1.00 1.22 .05Other admitting
diagnosis
1.04 0.97 1.12 .25 1.01 0.89 1.14 .88*All estimates of Variable Direct Cost analysis have been rounded to the nearest dollar
