REGIONAL VARIATION IN PEDIATRIC HOSPITALIZATION

儿科住院的地区差异

• 批准号: 3371678
• 负责人: JAMES M PERRIN
• 金额: $ 25.04万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 1990
• 资助国家: 美国
• 起止时间: 1990-09-01 至 1993-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3371678
• 关键词: child (0-11); gastrointestinal disorder; geographic site; head /neck injury; health care cost /financing; hospital length of stay; hospital utilization; human population study; human subject; medical records; meningitis; pediatrics; poisoning; prognosis; regional medical planning; respiratory disorder; socioeconomics

Children who live in Boston experience twice the risk of hospitalization for all medical conditions as do children living Rochester, NY. Children in New Haven, CT, sustain an intermediate risk. This proposal will identify several key factors underlying this variation and will clarify the health implications of hospitalization in these regions. The study will meet these objective through reviewing inpatients charts for all children residing in these three geographic areas and hospitalized for one of five conditions during 1988. These conditions include asthma/lower respiratory disease, meningitis, head trauma, abdominal pain/appendicitis and toxic ingestions. Data will be obtained to assess admission severity of illness, appropriateness of hospital use, attachment to primary care, the process leading to hospitalization and the cosioeconomic status of the child. In addition, outcome data will include severity at 72 hours, frequency of specified adverse events, and frequency of condition specific morbidities. Differences in the process of inpatient care will be documented as will be difference in hospitalization costs across the three regions. Severity will be determined via MedisGroups; appropriateness will be measured via the Pediatric Appropriateness Evaluation Protocol. Analyses using log-linear models will focus on whether the distribution of severity differs across these regions, how patient and health care factors influence severity, and whether these influences vary by region. By identifying factors underlying variation, and by clarifying health implications of hospitalization per se, this study will inform strategies for child health practices and policies directed towards improving outcomes and reducing costs.

住在波士顿的儿童住院风险是常住儿童的两倍 对于所有的医疗条件，就像住在纽约罗切斯特的孩子们一样。儿童 在康涅狄格州纽黑文，保持中等风险。这项提议将 找出这种差异背后的几个关键因素，并将澄清 在这些地区住院对健康的影响。 这项研究将通过审查住院病人图表来达到这些目标 居住在这三个地理区域并因以下原因住院的儿童 1988年期间的五种情况之一。这些情况包括哮喘/低 呼吸系统疾病、脑膜炎、头部创伤、腹痛/阑尾炎 和有毒的摄入。将获得数据以评估入院严重程度 疾病，医院使用的适当性，对初级保健的依恋， 导致住院的过程和老年人的社会经济地位 孩子。此外，结果数据将包括72小时的严重程度， 特定不良事件的发生频率和特定情况的发生频率 病态。住院护理过程中的差异将是 记录为将在三个地区的住院费用差异 地区。严重性将通过医疗组确定；适当性将 通过儿科适宜性评估方案进行衡量。 使用对数线性模型的分析将重点放在是否分布 这些地区的严重程度有所不同，患者和医疗保健因素 影响的严重性，以及这些影响是否因地区而异。 通过确定潜在的变异因素，并通过澄清健康 住院本身的影响，这项研究将为策略提供参考 用于儿童健康实践和旨在改善结果的政策 和降低成本。