Department of Pediatric Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
J Pediatr Surg. 2013 Jan;48(1):104-10. doi: 10.1016/j.jpedsurg.2012.10.025.
To characterize variation in practice patterns and resource utilization associated with the management of intussusception at Children's Hospitals.
A retrospective cohort study (1/1/09-6/30/11) of 27 Children's Hospitals participating in the Pediatric Health Information System database was performed. Hospitals were compared with regard to their rates of operative management following attempted enema reduction, prophylactic antibiotic utilization, same-day discharge for those successfully managed non-operatively, 48-h readmission rates, and case-related cost and charges.
2544 patients were identified (median: 93 cases/center) with a median age of 17 months. The rate of operation following attempted enema reduction varied significantly across hospitals (overall rate: 21.1%: range: 11%-62.8%; p<0.0001). For patients managed non-operatively, significant variability was found for prophylactic antibiotic utilization (overall rate: 23.3%; range: 1.4%-93.2%; p<0.0001), same-day discharge (overall rate: 15.2%; range: 0%-83.8%; p<0.0001), readmission rates (overall rate: 17.5%; range: 5.3%-32.1%; p<0.0001), treatment-related costs (overall median: $2490; range: $829-$5905; p<0.0001), and charges (overall median: $6350; range: $2497-$10,306; p<0.0001). Variability in costs and charges was even greater when analyzing all patients (operative and non-operative) with intussusception (overall cost median: $2865; range: $1574-$6763; p<0.0001; overall charge median: $7110; range: $3544-$22,097; p<0.0001).
Significant variation in practice patterns and resource utilization exists between Children's Hospitals in the management of intussusception. Prospective analysis of practice variation and appropriately risk-adjusted outcomes through a collaborative quality-improvement platform could accelerate the dissemination of best-practice guidelines for optimizing cost-effective care.
描述与小儿肠套叠管理相关的实践模式和资源利用的变化。
对参与儿科健康信息系统数据库的 27 家儿童医院进行回顾性队列研究（1/1/09-6/30/11）。比较医院在尝试灌肠复位后手术治疗的比例、预防性使用抗生素、成功非手术治疗的当天出院率、48 小时再入院率以及与病例相关的成本和费用。
共确定了 2544 名患者（中位数：93 例/中心），中位年龄为 17 个月。尝试灌肠复位后手术的比例在各医院之间差异显著（总体比例：21.1%：范围：11%-62.8%；p<0.0001）。对于非手术治疗的患者，预防性使用抗生素的比例存在显著差异（总体比例：23.3%：范围：1.4%-93.2%；p<0.0001）、当天出院（总体比例：15.2%：范围：0%-83.8%；p<0.0001）、再入院率（总体比例：17.5%：范围：5.3%-32.1%；p<0.0001）、治疗相关费用（总体中位数：2490 美元；范围：829 美元-5905 美元；p<0.0001）和费用（总体中位数：6350 美元；范围：2497 美元-10306 美元；p<0.0001）。分析所有肠套叠患者（手术和非手术）时，成本和费用的变异性更大（总体费用中位数：2865 美元；范围：1574 美元-6763 美元；p<0.0001；总体费用中位数：7110 美元；范围：3544 美元-22097 美元；p<0.0001）。
在小儿肠套叠管理方面，儿童医院之间的实践模式和资源利用存在显著差异。通过协作质量改进平台对实践差异进行前瞻性分析，并进行适当的风险调整后结果分析，可以加速最佳实践指南的传播，以优化具有成本效益的护理。
