We are pleased to have the opportunity to respond to the questions raised by Drs Kastner and Walsh, who have conducted research in the area of "disease management." First, we reported our findings encompassing all patients, including outliers. Many of us recall children with cystic fibrosis admitted for a "tune-up" or children with spina bifida who had decubitus ulcers who were hospitalized for months at a time. We included these patients because they result in significant costs to the health care system, and because programs to improve the management of chronic conditions often have the greatest effect on outliers. However, we did repeat the analysis using median rather than mean, which decreases the effect of outliers, and found that the average median length of stay decreased from approximately 30 days in the years between 1984 and 1989 to 5 to 6 days for the years between 1991 and 1996, still a significant decrease, both statistically and programmatically.
Liptak GS, Burns CM, Davidson PW, McAnarney E. Cost of Care Coordination for Children With Special Health Care Needs—Reply. Arch Pediatr Adolesc Med. 1999;153(9):1004. doi: