Variation in Emergency Department Admission Rates in US Children's Hospitals
Variation in Emergency Department Admission Rates in US Children's Hospitals
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DOI：
10.1542/peds.2014-1278
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发表时间：
2014-09-01
期刊：
影响因子：
8
通讯作者：
Neuman, Mark I.
中科院分区：
文献类型：
--
作者：
Bourgeois, Florence T.;Monuteaux, Michael C.;Neuman, Mark I.
目的：为了衡量医院水平的变化，在美国儿童hospitals.METHODS急诊科（ED）的儿童接受治疗的常见儿科疾病的入院率：我们进行了一项多中心的横断面研究的儿童介绍到ED的35个儿科三级保健医院参加儿科健康信息系统（PHIS）。计算2009年1月1日至2012年12月31日期间与7种常见疾病中的1种相关的访视的住院率，并根据医院水平的疾病严重程度进行校正。根据就诊频率和入院率系统地选择条件。结果：共有1288706例艾德（占所有病例的13.8%）与7种感兴趣的条件中的1种相关。在调整医院级别的严重程度后，观察到脑震荡（范围5%-72%）的入院率变化最大，其次是肺炎（19%-69%）和细支气管炎（19%-65%）。在癫痫发作（7%-37%）和肾脏和尿路感染（6%-37%）患者中发现的变异最小。虽然变异存在于特定疾病的入院率，某些医院一贯较高，和其他一贯较低，admission rates.CONCLUSIONS：我们观察到超过三倍的变化，严重程度调整后的常见儿科条件在美国儿童医院的入院率。虽然当地的做法和医院层面的因素可能会部分解释这种变化，我们的研究结果强调，需要更多地关注标准化的决定入院。
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.