Division of Inpatient Medicine, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington 98105, USA.
Pediatrics. 2013 Aug;132(2):229-36. doi: 10.1542/peds.2013-0359. Epub 2013 Jul 22.
We sought to characterize variation in hospital resource utilization and readmission for diabetic ketoacidosis (DKA) across US children's hospitals.
The study sample included a retrospective cohort of children aged 2 to 18 years with a diagnosis of DKA at 38 children's hospitals between 2004 and 2009. The main outcomes were resource utilization as determined by total standardized cost per hospitalization, overall and non-ICU length of stay (LOS), and readmission for DKA within 30 and 365 days.
There were 24,890 DKA admissions, and 20.3% of these were readmissions within 1 year. The mean hospital-level total standardized cost was $7142 (range $4125-$11,916). The mean hospital-level LOS was 2.5 days (1.5-3.7), and the non-ICU portion was 1.9 days (0.7-2.7). The mean hospital-level readmission within 365 days was 18.7% (6.5%-41.1%) and within 30 days was 2.5% (0.0%-7.1%). Hospital bed days overall, and in particular the non-ICU portion, accounted for the majority of the total standardized cost per hospitalization (overall 57%; non-ICU 36%) and explained most of the variation in resource use. Even after adjusting for difference in patient characteristics across hospitals, widespread differences existed across hospitals in total standardized cost, LOS, and readmission rates (P < .001).
Readmission for DKA within a year of hospitalization is common. US children's hospitals vary widely in resource use, hospital LOS, and readmission rates for patients with DKA. Our study highlights the need for additional research to understand these differences and to identify the most cost-effective strategies for managing diabetes across the continuum of care.
我们旨在描述美国儿童医院中糖尿病酮症酸中毒（DKA）患者的住院资源利用和再入院情况的差异。
本研究的样本包括 2004 年至 2009 年期间在 38 家儿童医院就诊的 2 至 18 岁确诊为 DKA 的儿童的回顾性队列。主要结局指标是通过每个住院的总标准化成本、总住院时间（LOS）和非 ICU 住院时间（LOS）以及 DKA 在 30 天和 365 天内的再入院率来确定的资源利用情况。
共纳入 24890 例 DKA 入院患者，其中 20.3%在 1 年内再入院。医院层面的平均总标准化成本为 7142 美元（范围为 4125-11916 美元）。医院层面的平均 LOS 为 2.5 天（1.5-3.7），非 ICU 部分为 1.9 天（0.7-2.7）。医院层面的 365 天内再入院率为 18.7%（6.5%-41.1%），30 天内再入院率为 2.5%（0.0%-7.1%）。总体而言，医院床位天数，特别是非 ICU 部分，占每个住院的总标准化成本的大部分（总体占 57%；非 ICU 占 36%），并解释了资源利用情况的大部分差异。即使在调整了医院间患者特征的差异后，在总标准化成本、LOS 和再入院率方面，医院间仍存在广泛差异（P<0.001）。
在住院后一年内 DKA 再入院很常见。美国儿童医院在 DKA 患者的资源利用、医院 LOS 和再入院率方面差异很大。我们的研究强调需要进一步研究，以了解这些差异，并确定在整个医疗保健连续性中管理糖尿病的最具成本效益的策略。
