Divisions of Hospital Medicine,
Divisions of Hospital Medicine.
Hosp Pediatr. 2021 Jun;11(6):554-562. doi: 10.1542/hpeds.2020-004044. Epub 2021 May 4.
Patient complexity at US children's hospitals is increasing. Hospitals experience concurrent pressure to reduce length of stay (LOS) and readmissions, yet little is known about how these common measures of resource use and quality have changed over time. Our aim was to examine temporal trends in medical complexity, hospital LOS, and readmissions across a sample of US children's hospitals.
Retrospective cohort study of hospitalized patients from 42 children's hospitals in the Pediatric Health Information System from 2013 to 2017. After excluding deaths, healthy newborns, obstetric care, and low volume service lines, we analyzed trends in medical complexity, LOS, and 14-day all-cause readmissions using generalized linear mixed effects models, adjusting for changes in patient factors and case-mix.
Between 2013 and 2017, a total of 3 355 815 discharges were included. Over time, the mean case-mix index and the proportion of hospitalized patients with complex chronic conditions or receiving intensive care increased ( < .001 for all). In adjusted analyses, mean LOS declined 3% (61.1 hours versus 59.3 hours from 2013 to 2017, < .001), whereas 14-day readmissions were unchanged (7.0% vs 6.9%; = .03). Reductions in adjusted LOS were noted in both medical and surgical service lines (3.6% and 2.0% decline, respectively; < .001).
Across US children's hospitals, adjusted LOS declined whereas readmissions remained stable, suggesting that children's hospitals are providing more efficient care for an increasingly complex patient population.
美国儿童医院患者的复杂性不断增加。医院同时面临着降低住院时间（LOS）和再入院率的压力，但对于这些常见的资源利用和质量衡量指标随时间的变化情况，我们知之甚少。我们的目的是研究美国儿童医院中医疗复杂性、住院时间和 14 天内全因再入院率的时间趋势。
这是一项回顾性队列研究，对象为来自 2013 年至 2017 年期间 Pediatric Health Information System 中 42 家儿童医院的住院患者。排除死亡、健康新生儿、产科护理和低容量服务线后，我们使用广义线性混合效应模型分析了医疗复杂性、住院时间和 14 天全因再入院率的趋势，调整了患者因素和病例组合的变化。
在 2013 年至 2017 年期间，共纳入了 3355815 例出院患者。随着时间的推移，平均病例组合指数和患有复杂慢性病或接受重症监护的住院患者比例增加（所有 P 值均<0.001）。在调整分析中，平均 LOS 下降了 3%（从 2013 年到 2017 年分别为 59.3 小时和 59.3 小时，P<0.001），而 14 天内的再入院率无变化（7.0%比 6.9%，P=0.03）。医疗和外科服务线的调整后 LOS 均有所下降（分别下降 3.6%和 2.0%，均 P<0.001）。
在美国儿童医院，调整后的 LOS 下降，而再入院率保持稳定，这表明儿童医院为越来越复杂的患者群体提供了更高效的护理。
