Rajendu Srivastava1, Charles J Homer. 1. Department of Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA. raj.srivastava@hsc.utah.edu
Abstract
OBJECTIVE: Pediatric teaching hospitals provide particular expertise in caring for children with complex or severe illnesses, yet most patients within teaching hospitals have common pediatric conditions. No study has determined whether children with common conditions remain hospitalized at teaching institutions longer than at nonteaching institutions. The objective of this study was to compare length of stay (LOS) for common pediatric conditions between teaching and nonteaching hospitals. METHODS: This study uses Massachusetts's hospital data for all discharged children ages 0 to 17 years for 1995 and 1996. Discharges were included when the principal diagnosis indicated asthma, bacterial pneumonia, convulsions, dehydration, failure to thrive, gastroenteritis, or urinary tract infections. Hospitals were classified as either teaching or nonteaching using the 1995-1996 American Hospital Association Guide. Children were identified as having a chronic condition when any discharge diagnosis was 1 of those on a previously published catalog of chronic childhood illnesses. The analysis tested the association of hospital type with LOS, controlling for chronic conditions, insurance type, age, race, diagnosis, mortality, and disposition using multivariate linear regression. RESULTS: Of 17 890 discharges for a common pediatric condition during the study period, 52.3% were from teaching hospitals. Twelve percent of common condition discharges also had a chronic disease diagnosis; 75.1% of these were discharged from a teaching hospital. LOS from nonteaching hospitals was shorter than from teaching hospitals (2.42 days vs 3.20 days). Although LOS for stays with a chronic diagnosis were longer than those without (4.75 days vs 2.56 days), controlling for chronic illness and other covariates did not eliminate the difference between LOS for nonteaching hospitals versus teaching hospitals (1.65 days vs 2.23 days). CONCLUSION: Pediatric patients with common conditions have a shorter LOS in nonteaching hospitals than those admitted to teaching hospitals by a little more than half a day. These results are unchanged when accounting for chronic conditions despite the expected results of preferential admissions to teaching hospitals for this group of patients. Additional studies should better characterize differences in patient populations, describe differences in processes, and identify differences in patient experience and outcomes to understand better the potential benefits of treating children with specific conditions at particular types of hospitals.
OBJECTIVE: Pediatric teaching hospitals provide particular expertise in caring for children with complex or severe illnesses, yet most patients within teaching hospitals have common pediatric conditions. No study has determined whether children with common conditions remain hospitalized at teaching institutions longer than at nonteaching institutions. The objective of this study was to compare length of stay (LOS) for common pediatric conditions between teaching and nonteaching hospitals. METHODS: This study uses Massachusetts's hospital data for all discharged children ages 0 to 17 years for 1995 and 1996. Discharges were included when the principal diagnosis indicated asthma, bacterial pneumonia, convulsions, dehydration, failure to thrive, gastroenteritis, or urinary tract infections. Hospitals were classified as either teaching or nonteaching using the 1995-1996 American Hospital Association Guide. Children were identified as having a chronic condition when any discharge diagnosis was 1 of those on a previously published catalog of chronic childhood illnesses. The analysis tested the association of hospital type with LOS, controlling for chronic conditions, insurance type, age, race, diagnosis, mortality, and disposition using multivariate linear regression. RESULTS: Of 17 890 discharges for a common pediatric condition during the study period, 52.3% were from teaching hospitals. Twelve percent of common condition discharges also had a chronic disease diagnosis; 75.1% of these were discharged from a teaching hospital. LOS from nonteaching hospitals was shorter than from teaching hospitals (2.42 days vs 3.20 days). Although LOS for stays with a chronic diagnosis were longer than those without (4.75 days vs 2.56 days), controlling for chronic illness and other covariates did not eliminate the difference between LOS for nonteaching hospitals versus teaching hospitals (1.65 days vs 2.23 days). CONCLUSION: Pediatric patients with common conditions have a shorter LOS in nonteaching hospitals than those admitted to teaching hospitals by a little more than half a day. These results are unchanged when accounting for chronic conditions despite the expected results of preferential admissions to teaching hospitals for this group of patients. Additional studies should better characterize differences in patient populations, describe differences in processes, and identify differences in patient experience and outcomes to understand better the potential benefits of treating children with specific conditions at particular types of hospitals.