Resource Utilization Among Inpatients with Rheumatoid Arthritis - An Analysis of 2002 - 2004 Healthcare Cost and Utilization Project Data

Defense Date


Graduation Date

Spring 1-1-2008


Campus Only

Submission Type


Degree Name



Pharmacy Administration


School of Pharmacy

Committee Chair

Khalid Kamal

Committee Member

Monica Skomo

Committee Member

Michael J. Smith

Committee Member

David Johnson


Rheumatoid arthritis, Hospitalization, Healthcare Cost and Utilization Project (HCUP), Hospital charges, Hospital length of stay, Retrospective analysis


Objective: To describe differences and trends in hospitalization outcomes such as length of stay (LOS) and total hospital charges for patients with rheumatoid arthritis (RA) using the Healthcare Cost and Utilization Project (HCUP) Dataset.

Methods: A retrospective analysis was conducted using a 20% sample from the Nationwide Inpatient Sample (NIS) of the HCUP data. NIS is an all-payer inpatient care database that contains hospital discharge data from a national sample of more than 1,000 hospitals. NIS datasets of 2002, 2003, and 2004 were utilized in this study. Hospitalizations for patients with RA (primary diagnosis using International Classification of Diseases (ICD)-9 code 714.0) were extracted. Descriptive analysis was conducted to describe the patient- (age, race, gender, payer status, patient location, and median household income), hospital- (bed-size, geographic region, location, and teaching status) and outcome-related variables (LOS and total hospital charges). A multiple regression model was used to identify patient- and hospital-related predictors of LOS and total charges among hospitalizations for patients with RA. Further, a descriptive analysis was conducted to assess the trends in LOS, total charges, and principal procedures conducted in RA.

Results: A total number of 744 hospitalized RA cases were observed in 2002, 612 cases in 2003 and 655 cases in 2004. The mean age was 61.92 years and the hospitalizations were predominantly reported in females (79.3%) and whites (68.8%). The payer variable ‘private insurance' was found to be a predictor of LOS while the predictors for total charges included race (Hispanics), age (61-70 years), and geographic location (Western region). LOS as well as total charges showed an increasing trend from 2002 through 2004. Total knee replacement (TKR) and total hip replacement (THR) comprised of majority of the procedures conducted in all three years.

Conclusion: Even though the number of hospitalizations for RA is decreasing, there is an increasing trend in the average LOS and total charges. The increase in surgical procedures could be a contributing factor to the longer LOS and higher total charges. Successful interventions that take into account important RA-related patient- and hospital-related characteristics could result in improved health outcomes and substantial cost savings in this population.





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