Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA.
Acad Pediatr. 2011 Jul-Aug;11(4):263-79. doi: 10.1016/j.acap.2011.04.002. Epub 2011 Jun 2.
The aim of this study was to describe selected trends in hospital inpatient care for children between 2000 and 2007.
Analysis was conducted of administrative data from annual nationwide databases of hospital discharges from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, along with survey data from a nationally representative random sample of children from the Medical Expenditure Panel Survey. Hospital utilization rates and expenses, risk-adjusted rates of potentially avoidable hospitalization, and safety indicators in the hospital are calculated and tracked with established and downloadable software.
The rate of hospital discharges for children aged 15 to 17 years declined significantly, mainly due to fewer maternity-related discharges. The leading principal conditions by age group were similar to the report for 1995 to 2000; however, the rate of admissions for skin infections doubled to 9 per 10,000. Hospital cost per discharge increased by an annual average of 4.5% per year compared with 2.6% annual growth in the gross domestic product deflator. Medicaid is increasingly important relative to private insurance as a payer for hospital care for children. The rate of potentially preventable hospitalizations for both acute and chronic conditions declined substantially (18%, adjusted for age and gender). Several measures of patient safety improved--the rates of postoperative sepsis, iatrogenic pneumothorax, and selected infections due to medical care declined by 14.2%, 17.8%, and 23.5%, respectively. However, the rate of accidental punctures and lacerations and the rate of decubitus ulcer increased by 25.6% and 34.5%, respectively. The trends in safety indicators varied somewhat by age group, income quartile of zip codes, insurance, region, and type of location without a consistent pattern.
CONCLUSIONS/IMPLICATIONS: Although teenage pregnancy rates were declining, there was a worsening trend in skin infections. The latter may eventually be impacted by recent publication of new guidelines for treatment by office-based physicians. A gradually increasing role of Medicaid as a payer for hospital care for children will likely put an increasing strain on public resources in advance of the full implementation of the health insurance reforms recently enacted. The decline in potentially avoidable admissions reduces the use of the most expensive resources. For asthma and diabetes, children in the lowest income zip codes had persistently higher rates of admission, but the rate fell by one third during the period. Children in the South and West regions had substantial and significant declines in preventable admissions. Particular indicators of safety were improving, whereas others were worsening. Trends were not the same in all types of hospitals, all regions, and income categories. This is already a rich area for further research on the impact of quality improvement strategies; however, attention is needed to developing more tools to more thoroughly track quality of care for children.
本研究旨在描述 2000 年至 2007 年期间儿童住院治疗的部分趋势。
对来自医疗机构成本和利用项目医疗保健研究和质量局年度全国性医院出院数据库的行政数据以及来自医疗支出面板调查的全国代表性儿童随机抽样调查数据进行了分析。利用既定的、可下载的软件，计算和跟踪医院利用率和费用、潜在可避免住院的风险调整率以及医院安全指标。
15 至 17 岁儿童的住院出院率显著下降，主要是由于与分娩相关的出院率下降。按年龄组划分的主要疾病与 1995 年至 2000 年的报告相似；然而，皮肤感染的入院率翻了一番，达到每 10000 人 9 例。与国内生产总值平减指数 2.6%的年增长率相比，每次出院的医院费用平均每年增长 4.5%。与私人保险相比，医疗补助作为儿童住院治疗的支付方越来越重要。急性和慢性疾病的潜在可预防住院率大幅下降（按年龄和性别调整后下降 18%）。一些患者安全指标有所改善——术后败血症、医源性气胸和因医疗护理导致的选定感染的发生率分别下降了 14.2%、17.8%和 23.5%。然而，意外刺穿和撕裂以及褥疮的发生率分别上升了 25.6%和 34.5%。安全指标的趋势因年龄组、邮政编码的收入四分位数、保险、地区和无特定类型的位置而有所不同，没有一致的模式。
结论/意义：尽管青少年怀孕率有所下降，但皮肤感染的趋势却在恶化。后者可能最终会受到最近发布的新的门诊医生治疗指南的影响。医疗补助作为儿童住院治疗支付方的作用逐渐增强，可能会在最近颁布的医疗保险改革全面实施之前，给公共资源带来越来越大的压力。潜在可避免入院人数的减少减少了对最昂贵资源的使用。对于哮喘和糖尿病，收入最低的邮政编码的儿童入院率一直较高，但在此期间下降了三分之一。南部和西部地区的儿童的可预防入院人数大幅下降。特定的安全指标有所改善，而其他指标则在恶化。在所有类型的医院、所有地区和收入类别中，趋势并不相同。这已经是一个深入研究质量改进策略影响的丰富领域；然而，需要注意开发更多工具，以更全面地跟踪儿童的护理质量。
