Author:
Bourgeois Florence T.,Monuteaux Michael C.,Stack Anne M.,Neuman Mark I.
Abstract
OBJECTIVE:
To measure the hospital-level variation in admission rates for children receiving treatment of common pediatric illnesses across emergency departments (EDs) in US children’s hospitals.
METHODS:
We performed a multi-center cross sectional study of children presenting to the EDs of 35 pediatric tertiary-care hospitals participating in the Pediatric Health Information System (PHIS). Admission rates were calculated for visits occurring between January 1, 2009, and December 31, 2012, associated with 1 of 7 common conditions, and corrected to adjust for hospital-level severity of illness. Conditions were selected systematically based on frequency of visits and admission rates.
RESULTS:
A total of 1 288 706 ED encounters (13.8% of all encounters) were associated with 1 of the 7 conditions of interest. After adjusting for hospital-level severity, the greatest variation in admission rates was observed for concussion (range 5%–72%), followed by pneumonia (19%–69%), and bronchiolitis (19%–65%). The least variation was found among patients presenting with seizures (7%–37%) and kidney and urinary tract infections (6%–37%). Although variability existed in disease-specific admission rates, certain hospitals had consistently higher, and others consistently lower, admission rates.
CONCLUSIONS:
We observed greater than threefold variation in severity-adjusted admission rates for common pediatric conditions across US children’s hospitals. Although local practices and hospital-level factors may partly explain this variation, our findings highlight the need for greater focus on the standardization of decisions regarding admission.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics, Perinatology and Child Health
Cited by
61 articles.
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