Center for Applied Research and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Acad Pediatr. 2012 Sep-Oct;12(5):436-44. doi: 10.1016/j.acap.2012.06.006. Epub 2012 Aug 24.
Reducing the number of preventable hospitalizations represents a possible source of health care savings. However, the current literature lacks a description of the extent of potentially preventable pediatric hospitalizations. The study objectives are to (1) identify the charges and (2) demographic characteristics associated with potentially preventable pediatric hospitalizations.
Secondary analysis of the 2006 Kids' Inpatient Database (weighted N = 7,558,812). International Classification of Diseases, Ninth Revision, Clinical Modification codes for 16 previously validated pediatric ambulatory care-sensitive (ACS) conditions identified potentially preventable hospitalizations; seven additional conditions reflected updated care guidelines. Outcome variables included number of admissions, hospitalization days, and hospital charges. Demographic and diagnostic variables associated with an ACS condition were compared with regression analyses by the use of appropriate person-level weights.
Pediatric ACS hospitalizations totaled $4.05B in charges and 1,087,570 hospitalization days in 2006. Two respiratory conditions-asthma and bacterial pneumonia-comprised 48.4% of ACS hospital charges and 46.7% of ACS hospitalization days. In multivariate analysis, variables associated with an ACS condition included: male gender (odds ratio [OR] 1.10; 95% confidence interval [95% CI] 1.07-1.13); race/ethnicity of black (OR 1.22; 95% CI 1.16-1.27) or Hispanic (OR 1.12; 95% CI 1.06-1.18); and emergency department as admission source (OR 1.37; 95% CI 1.27-1.48).
Respiratory conditions comprised the largest proportion of potentially preventable pediatric hospitalizations, totaling as much as $1.96B in hospital charges. Children hospitalized with an ACS condition tend to be male, non-white, and admitted through the emergency department. Future research to prevent pediatric hospitalizations should examine targeted interventions in the primary care setting, specifically around respiratory conditions and minority populations.
减少可预防的住院治疗次数是节省医疗保健费用的一种可能途径。然而，目前的文献缺乏对潜在可预防儿科住院治疗程度的描述。本研究的目的是：（1）确定费用；（2）确定与潜在可预防儿科住院治疗相关的人口统计学特征。
对 2006 年儿童住院数据库（加权 N=7558812）进行二次分析。采用国际疾病分类，第九版临床修正版，对 16 种先前经过验证的儿科门诊医疗保健敏感（ACS）疾病的代码进行分类，以确定潜在可预防的住院治疗情况；另外 7 种疾病反映了更新的治疗指南。结果变量包括入院次数、住院天数和住院费用。使用适当的个人水平权重，通过回归分析比较与 ACS 疾病相关的人口统计学和诊断变量。
2006 年，儿科 ACS 住院治疗的费用为 40.5 亿美元，住院天数为 1087570 天。两种呼吸系统疾病——哮喘和细菌性肺炎——占 ACS 住院费用的 48.4%，占 ACS 住院天数的 46.7%。在多变量分析中，与 ACS 疾病相关的变量包括：男性（比值比[OR]1.10；95%置信区间[95%CI]1.07-1.13）；黑种人（OR 1.22；95%CI 1.16-1.27）或西班牙裔（OR 1.12；95%CI 1.06-1.18）；以及急诊为入院来源（OR 1.37；95%CI 1.27-1.48）。
呼吸系统疾病占潜在可预防儿科住院治疗的最大比例，其住院费用总计高达 19.6 亿美元。患有 ACS 疾病的住院儿童往往是男性、非白人，并且通过急诊入院。未来预防儿科住院治疗的研究应在初级保健环境中，特别是在呼吸系统疾病和少数民族群体中，检查有针对性的干预措施。
