Children's Mercy Hospital, Kansas City, Missouri;
Children's Mercy Hospital, Kansas City, Missouri.
Pediatrics. 2021 Apr;147(4). doi: 10.1542/peds.2020-013490. Epub 2021 Mar 11.
High costs associated with hospitalization have encouraged reductions in unnecessary encounters. A subset of observation status patients receive minimal interventions and incur low use costs. These patients may contain a cohort that could safely be treated outside of the hospital. Thus, we sought to describe characteristics of low resource use (LRU) observation status hospitalizations and variation in LRU stays across hospitals.
We conducted a retrospective cohort study of pediatric observation encounters at 42 hospitals contributing to the Pediatric Health Information System database from January 1, 2019, to December 31, 2019. For each hospitalization, we calculated the use ratio (nonroom costs to total hospitalization cost). We grouped stays into use quartiles with the lowest labeled LRU. We described associations with LRU stays and performed classification and regression tree analyses to identify the combination of characteristics most associated with LRU. Finally, we described the proportion of LRU hospitalizations across hospitals.
We identified 174 315 observation encounters (44 422 LRU). Children <1 year (odds ratio [OR] 3.3; 95% confidence interval [CI] 3.1-3.4), without complex chronic conditions (OR 3.6; 95% CI 3.2-4.0), and those directly admitted (OR 4.2; 95% CI 4.1-4.4) had the greatest odds of experiencing an LRU encounter. Those children with the combination of direct admission, no medical complexity, and a respiratory diagnosis experienced an LRU stay 69.5% of the time. We observed variation in LRU encounters (1%-57% of observation encounters) across hospitals.
LRU observation encounters are variable across children's hospitals. These stays may include a cohort of patients who could be treated outside of the hospital.
与住院相关的高成本促使人们减少不必要的就诊次数。一部分观察状态的患者接受的干预措施较少，使用成本较低。这些患者可能包含一个可以在医院外安全治疗的队列。因此，我们试图描述低资源使用（LRU）观察状态住院的特征，并研究医院间 LRU 住院时间的变化。
我们对 2019 年 1 月 1 日至 2019 年 12 月 31 日期间参与儿科健康信息系统数据库的 42 家医院的儿科观察就诊进行了回顾性队列研究。对于每次住院，我们计算了使用比率（非病房费用与总住院费用的比率）。我们将住院时间分为使用四分位数，最低的标记为 LRU。我们描述了与 LRU 住院时间的关联，并进行分类和回归树分析，以确定与 LRU 最相关的特征组合。最后，我们描述了医院间 LRU 住院的比例。
我们共确定了 174315 例观察就诊（44422 例 LRU）。年龄<1 岁（比值比[OR]3.3；95%置信区间[CI]3.1-3.4）、无复杂慢性病（OR 3.6；95%CI 3.2-4.0）和直接入院的儿童（OR 4.2；95%CI 4.1-4.4）发生 LRU 就诊的可能性最大。直接入院、无医疗复杂性和呼吸道诊断的儿童中，有 69.5%的人经历了 LRU 住院。我们观察到医院间 LRU 就诊的变化（观察就诊的 1%-57%）。
LRU 观察就诊在儿童医院之间存在差异。这些住院时间可能包含可以在医院外治疗的患者队列。
