Variability in Processes of Care and Outcomes Among Children Hospitalized With Community-acquired Pneumonia.
Brogan, Thomas V. MD *; Hall, Matthew PhD +; Williams, Derek J. MD, MPH ++; Neuman, Mark I. MD, MPH [S]; Grijalva, Carlos G. MD, MPH [P]; Farris, Reid W.D. MD *; Shah, Samir S. MD, MSCE [forms double vertical]
Pediatric Infectious Disease Journal.
31(10):1036-1041, October 2012.
(Format: HTML, PDF)
Background: Substantial care variation occurs in a number of pediatric diseases.
Methods: We evaluated the variability in healthcare resource utilization and its association with clinical outcomes among children, aged 1-18 years, hospitalized with community-acquired pneumonia (CAP). Each of 29 children's hospitals contributing data to the Pediatric Hospital Information System was ranked based on the proportion of CAP patients receiving each of 8 diagnostic tests. Primary outcome variable was length of stay (LOS), revisit to the emergency department or readmission within 14 days of discharge.
Results: Of 21,213 children hospitalized with nonsevere CAP, median age was 3 years (interquartile range: 1-6 years). Laboratory testing and antibiotic usage varied widely across hospitals; cephalosporins were the most commonly prescribed antibiotic. There were large differences in the processes of care by age categories. The median LOS was 2 days (interquartile range: 1-3 days) and differed across hospitals; 25% of hospitals had median LOS >= 3 days. Hospital-level variation occurred in 14-day emergency department visits and 14-day readmission, ranging from 0.9% to 4.9% and from 1.5% to 4.4%, respectively. Increased utilization of diagnostic testing was associated with longer hospital LOS (P = 0.036) but not with probability of 14-day readmission (Spearman [rho] = 0.234; P = 0.225). There was an inverse correlation between LOS and 14-day revisit to the emergency department ([rho] = -0.48; P = 0.013).
Conclusions: Wide variability occurred in diagnostic testing for children hospitalized with CAP. Increased diagnostic testing was associated with a longer LOS. Earlier hospital discharge did not correlate with increased 14-day readmission. The precise interaction of increased use with longer LOS remains unclear.
(C) 2012 Lippincott Williams & Wilkins, Inc.