Section of Hospital Medicine, Department of Pediatrics, Clinical Effectiveness Team, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.
Children's Hospital Association, Lenexa, Kansas, USA.
J Hosp Med. 2022 Jun;17(6):417-426. doi: 10.1002/jhm.12811. Epub 2022 Mar 27.
Previously few means existed to broadly examine variability across conditions/practices within or between hospitals for common pediatric conditions.
Our objective was to develop a novel empiric measure of variation in care and test its association with patient-centered outcomes.
We conducted a retrospective cohort study of children hospitalized from January 2016 to December 2018 using the Pediatric Hospital Information Systems database.
We included children ages 0-18 years hospitalized with asthma, bronchiolitis, or gastroenteritis.
We developed a hospital-specific measure of variation in care, the hospital's observed specific standard practice (HOSSP), the most common combination of laboratory studies, imaging, and medications used at each hospital.
The outcomes were standardized costs, length of stay (LOS), and 7-day all-cause readmissions.
Among 133,392 hospitalizations from 41 hospitals (asthma = 50,382, bronchiolitis = 54,745, and gastroenteritis = 28,265), there was significant variation in overall HOSSP adherence across hospitals for these conditions (asthma: 3.5%-47.4% [p < .001], bronchiolitis: 2.5%-19.8% [p < .001], gastroenteritis: 1.6%-11.6% [p < .001]). The majority of HOSSP variation was driven by differences in medication prescribing for asthma and bronchiolitis and laboratory ordering for gastroenteritis. For all three conditions, greater HOSSP adherence was associated with significantly lower hospital costs (asthma: p = .04, bronchiolitis: p < .001, acute gastroenteritis: p = .01), without increases in LOS or 7-day all cause readmissions.
We found substantial variation in the components and adherence to HOSSP. Hospitals with greater HOSSP adherence had lower costs for these conditions. This suggests hospitals can use data around laboratory, imaging, and medication prescribing practices to drive standardization of care, reduce unnecessary testing and treatment, determine best practices, and reduce costs.
之前，很少有方法可以广泛地检查医院内或医院间常见儿科疾病的条件/实践的变异性。
我们的目的是开发一种新的经验性护理变异性衡量方法，并测试其与以患者为中心的结果的相关性。
我们使用儿科医院信息系统数据库对 2016 年 1 月至 2018 年 12 月住院的儿童进行了回顾性队列研究。
我们纳入了年龄在 0-18 岁的患有哮喘、细支气管炎或胃肠炎的住院儿童。
我们开发了一种医院特定的护理变异性衡量方法，即医院观察到的特定标准实践（HOSSP），这是每个医院使用的最常见的实验室研究、影像学和药物组合。
结果是标准化成本、住院时间（LOS）和 7 天全因再入院率。
在来自 41 家医院的 133392 例住院治疗中（哮喘=50382 例，细支气管炎=54745 例，胃肠炎=28265 例），这些疾病的整体 HOSSP 依从性在医院间存在显著差异（哮喘：3.5%-47.4%[p<0.001]，细支气管炎：2.5%-19.8%[p<0.001]，胃肠炎：1.6%-11.6%[p<0.001]）。HOSSP 变异的大部分是由哮喘和细支气管炎的药物处方和胃肠病的实验室检查差异驱动的。对于所有三种疾病，HOSSP 更高的依从性与医院成本显著降低相关（哮喘：p=0.04，细支气管炎：p<0.001，急性胃肠炎：p=0.01），而不会增加 LOS 或 7 天全因再入院率。
我们发现 HOSSP 的组成和依从性存在很大差异。HOSSP 依从性更高的医院的这些疾病的成本更低。这表明医院可以使用实验室、影像学和药物处方实践的数据来推动护理标准化，减少不必要的检查和治疗，确定最佳实践，并降低成本。
