Aleisha M Nabower1, Matt Hall2, Jason Burrows3, Amanda Dave3, Ashley Deschamp3, Chinenye R Dike3, Joshua C Euteneuer3, Teri Mauch3, Russell McCulloh3, Laura Ortmann3, Kari Simonsen3, Gwenn Skar3, Jessica Snowden4, Veronica Taylor3, Jessica L Markham5. 1. Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, Nebraska; aleisha.nabower@unmc.edu. 2. Children's Hospital Association, Lenexa, Kansas. 3. Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, Nebraska. 4. Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and. 5. Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.
Abstract
OBJECTIVES: Assess trends in inpatient acute gastroenteritis (AGE) management across children's hospitals and identify elements of AGE management associated with resource use. METHODS: We examined inpatient stays for children 6 months to 18 years hospitalized with AGE from 2009 to 2018 using the Pediatric Health Information System database. We characterized demographics, hospital-level resource use (ie, medications, laboratories, and imaging), and outcomes (ie, cost per case, 14-day revisit rates, and length of stay [LOS]). We compared demographic characteristics and resource use between 2009 to 2013 and 2014 to 2018 using χ2 and Wilcoxon rank-sum tests. We grouped hospitals on the basis of 2009 use of each resource and trended use over time using logistic regression. Annual change in mean cost and LOS were estimated by using models of log-transformed data. RESULTS: Across 32 354 hospitalizations at 38 hospitals, there was a high use of electrolyte testing (85.4%) and intravenous fluids (84.1%) without substantial changes over time. There were significant reductions in the majority of laboratory, medication, and imaging resources across hospitals over the study period. The most notable reductions were for rotavirus and stool testing. Many hospitals saw a decrease in LOS, with only 3 noting an increased revisit rate. Reductions in cost per case over time were most associated with decreases in imaging, laboratory testing, and LOS. CONCLUSIONS: Significant variation in resource use for children hospitalized with AGE coupled with high use of resources discouraged in AGE guidelines highlights potential opportunities to improve resource use that may be addressed in future AGE guidelines and quality improvement initiatives.
OBJECTIVES: Assess trends in inpatient acute gastroenteritis (AGE) management across children's hospitals and identify elements of AGE management associated with resource use. METHODS: We examined inpatient stays for children 6 months to 18 years hospitalized with AGE from 2009 to 2018 using the Pediatric Health Information System database. We characterized demographics, hospital-level resource use (ie, medications, laboratories, and imaging), and outcomes (ie, cost per case, 14-day revisit rates, and length of stay [LOS]). We compared demographic characteristics and resource use between 2009 to 2013 and 2014 to 2018 using χ2 and Wilcoxon rank-sum tests. We grouped hospitals on the basis of 2009 use of each resource and trended use over time using logistic regression. Annual change in mean cost and LOS were estimated by using models of log-transformed data. RESULTS: Across 32 354 hospitalizations at 38 hospitals, there was a high use of electrolyte testing (85.4%) and intravenous fluids (84.1%) without substantial changes over time. There were significant reductions in the majority of laboratory, medication, and imaging resources across hospitals over the study period. The most notable reductions were for rotavirus and stool testing. Many hospitals saw a decrease in LOS, with only 3 noting an increased revisit rate. Reductions in cost per case over time were most associated with decreases in imaging, laboratory testing, and LOS. CONCLUSIONS: Significant variation in resource use for children hospitalized with AGE coupled with high use of resources discouraged in AGE guidelines highlights potential opportunities to improve resource use that may be addressed in future AGE guidelines and quality improvement initiatives.
Authors: Eyal Leshem; Jacqueline E Tate; Claudia A Steiner; Aaron T Curns; Ben A Lopman; Umesh D Parashar Journal: JAMA Date: 2015-06-09 Impact factor: 56.272
Authors: Carrie H Lind; Matt Hall; Donald H Arnold; Whitney Browning; David P Johnson; Gregory Plemmons; Nusrat Zaman; Derek J Williams Journal: Hosp Pediatr Date: 2016-12