McLeod Lisa, French Benjamin, Dai Dingwei, Localio Russell, Keren Ron
Department of Pediatrics, Children's Hospital of Philadelphia, PA 19104, USA.
Arch Pediatr Adolesc Med. 2011 Sep;165(9):857-63. doi: 10.1001/archpediatrics.2011.132.
To explore the relationship between the volume of children admitted to the hospital with acute gastroenteritis and adherence to recommended quality indicators.
Retrospective cohort study.
Premier Perspective clinical and financial information systems database (Premier Inc, Charlotte, North Carolina).
A total of 12,604 otherwise healthy children aged 3 months to 10 years hospitalized between January 1, 2007, and December 31, 2009, at 280 US hospitals with International Classification of Diseases, Ninth Revision diagnosis codes indicating acute gastroenteritis.
Volume of hospital admissions per year of children with acute gastroenteritis.
Quality indicators for overuse and misuse of care in the management of acute gastroenteritis based on nationally published guidelines. These include blood testing, stool studies, use of antibiotics, and use of nonrecommended antiemetic or antidiarrheal medications (hereafter referred to as nonrecommended medications).
Selected blood, stool, and rotavirus tests (overuse indicators) were performed in 85%, 46%, and 56% of children, respectively. Six percent of children received nonrecommended medications, and 26% received antibiotics (misuse indicators). Higher volumes of hospital admission for acute gastroenteritis were associated with less use of blood tests (odds ratio [OR], 0.67 [95% confidence interval {CI}, 0.50-0.89]), nonrecommended medications (OR, 0.84 [95% CI, 0.76-0.93]), and antibiotics (OR, 0.93 [95% CI, 0.86-0.99]). Children admitted to hospitals in the 25th vs 75th percentile of patient volume had a 10%, 30%, and 10% increased chance of having blood tests, nonrecommended medications, and antibiotics ordered, respectively.
In a nationally representative sample of hospitals that care for children with acute gastroenteritis, higher patient volumes were associated with greater adherence to established quality indicators. Further investigation is needed to identify the hospital characteristics driving the volume-quality relationship for this common pediatric condition.
探讨因急性胃肠炎住院的儿童数量与遵循推荐的质量指标之间的关系。
回顾性队列研究。
Premier Perspective临床和财务信息系统数据库（Premier公司，北卡罗来纳州夏洛特）。
2007年1月1日至2009年12月31日期间，美国280家医院收治的12604名3个月至10岁的健康儿童，其国际疾病分类第九版诊断代码显示为急性胃肠炎。
每年因急性胃肠炎住院的儿童数量。
基于全国发布的指南，急性胃肠炎管理中过度使用和不当使用医疗服务的质量指标。这些指标包括血液检查、粪便检查、抗生素使用以及使用非推荐的止吐药或止泻药（以下简称非推荐药物）。
分别有85%、46%和56%的儿童接受了选定的血液、粪便和轮状病毒检测（过度使用指标）。6%的儿童使用了非推荐药物，26%的儿童使用了抗生素（不当使用指标）。因急性胃肠炎住院人数较多与血液检查（比值比[OR]，0.67[95%置信区间{CI}，0.50 - 0.89]）、非推荐药物（OR，0.84[95%CI，0.76 - 0.93]）和抗生素（OR，0.93[95%CI，0.86 - 0.99]）的使用减少有关。患者数量处于第25百分位数与第75百分位数的医院收治的儿童，接受血液检查、非推荐药物和抗生素医嘱的可能性分别增加了10%、30%和10%。
在全国具有代表性的照顾急性胃肠炎儿童的医院样本中，患者数量较多与更严格遵循既定质量指标相关。需要进一步调查以确定导致这种常见儿科疾病数量 - 质量关系的医院特征。
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