Changing patterns of routine laboratory testing over time at children's hospitals.
Changing patterns of routine laboratory testing over time at children's hospitals.
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随着时间的推移，儿童医院的常规实验室检测模式正在发生变化。
DOI：
10.1002/jhm.13372
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发表时间：
2024
影响因子：
2.6
通讯作者：
Cotter,JillianM
中科院分区：
文献类型：
--
作者：
Tchou,MichaelJ;Hall,Matt;Markham,JessicaL;Stephens,JohnR;Steiner,MichaelJ;McCoy,Elisha;Aronson,PaulL;Shah,SamirS;Molloy,MatthewJ;Cotter,JillianM
背景对儿童医院低价值常规检测的研究并没有一致地评估随时间变化的检测模式。目标确定十年来儿童医院常规实验室检测率的变化以及与患者结果的关联。设计、设置和参与者我们对儿科健康信息系统数据库中 28 家儿童医院因常见、较低严重程度诊断而住院的 0-18 岁儿童进行了一项多中心、回顾性队列研究。主要结果和措施我们计算了 2010 年至 2019 年间每家医院全血细胞计数、电解质和炎症标志物的平均年检测率。每年平均检测率变化 >2% 被定义为具有临床意义，并用于将医院分为几组：检测率增加、减少和不变。比较各组的住院时间、费用和 30 天再入院或急诊室复诊的差异，并根据人口统计数据和病例组合指数进行调整。结果我们的研究包括 576,572 例常见、低严重性诊断的病例。研究中每年各医院的检测率从每位患者每天 0.3 次到 1.4 次检测不等。医院特定检测率的平均年变化范围为 –6% 至 +7%。在整个 10 年的研究中，四家医院仍处于测试最低四分位数，两家医院处于最高四分位数。我们对检测率上升 (8)、下降 (n= 5) 和不变 (n= 15) 的医院进行分组。各亚组在费用、住院时间、30 天急诊复诊或再入院率方面没有发现差异。比较一段时间内的资源利用率趋势可以为可实现的测试减少率提供重要见解。
BackgroundResearch into low‐value routine testing at children's hospitals has not consistently evaluated changing patterns of testing over time.ObjectivesTo identify changes in routine laboratory testing rates at children's hospitals over ten years and the association with patient outcomes.Design, Settings, and ParticipantsWe performed a multi‐center, retrospective cohort study of children aged 0–18 hospitalized with common, lower‐severity diagnoses at 28 children's hospitals in the Pediatric Health Information Systems database.Main Outcomes and MeasuresWe calculated average annual testing rates for complete blood counts, electrolytes, and inflammatory markers between 2010 and 2019 for each hospital. A >2% average testing rate change per year was defined as clinically meaningful and used to separate hospitals into groups: increasing, decreasing, and unchanged testing rates. Groups were compared for differences in length of stay, cost, and 30‐day readmission or ED revisit, adjusted for demographics and case mix index.ResultsOur study included 576,572 encounters for common, low‐severity diagnoses. Individual hospital testing rates in each year of the study varied from 0.3 to 1.4 tests per patient day. The average yearly change in hospital‐specific testing rates ranged from –6% to +7%. Four hospitals remained in the lowest quartile of testing and two in the highest quartile throughout all 10 years of the study. We grouped hospitals with increasing (8), decreasing (n= 5), and unchanged (n= 15) testing rates. No difference was found across subgroups in costs, length of stay, 30‐day ED revisit, or readmission rates. Comparing resource utilization trends over time provides important insights into achievable rates of testing reduction.