Variability in processes of care and outcomes among children hospitalized with community-acquired pneumonia.

Brogan TV, Hall M, Williams DJ, Neuman MI, Grijalva CG, Farris RW, Shah SS
Pediatr Infect Dis J. 2012 31 (10): 1036-41

PMID: 22653486 · PMCID: PMC3504613 · DOI:10.1097/INF.0b013e31825f2b10

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 ρ = 0.234; P = 0.225). There was an inverse correlation between LOS and 14-day revisit to the emergency department (ρ = -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.

MeSH Terms (16)

Adolescent Child Child, Preschool Community-Acquired Infections Diagnostic Services Female Health Services Research Hospitals, Pediatric Humans Infant Length of Stay Male Patient Readmission Pneumonia Standard of Care Treatment Outcome

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