REGIONAL VARIATION IN PEDIATRIC HOSPITALIZATION

住在波士顿的儿童经历住院治疗的风险是波士顿的两倍 对于所有的医疗条件一样，儿童生活罗切斯特，纽约。 儿童 在纽黑文，CT，维持中等风险。 这项建议会 确定这种差异背后的几个关键因素，并将澄清 这些地区住院治疗的健康影响。 该研究将通过审查住院患者图表来实现这些目标， 所有居住在这三个地理区域并因下列原因住院的儿童： 1988年的五个条件之一。 这些疾病包括哮喘/低 呼吸道疾病、脑膜炎、头部创伤、腹痛/阑尾炎 和有毒的摄入物。 将获得数据以评估入院严重程度 疾病，医院使用的适当性，对初级保健的重视， 导致住院的过程和住院病人的经济状况 孩子 此外，结局数据将包括72小时时的严重程度， 特定不良事件的频率和特定疾病的频率 病态 住院治疗过程中的差异将是 记录了三个医院的住院费用差异 地区 将通过MedisGroups确定严重度;适当性将 通过儿科适当性评估方案进行测量。 使用对数线性模型的分析将侧重于 这些地区的严重程度不同，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。 通过识别变异的潜在因素， 住院本身的影响，这项研究将告知战略 儿童健康实践和政策，旨在改善结果 并且降低成本。

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.