Tian Yao, Macy Michelle L, Hockenberry Jason M, Holl Jane L, Sabbatini Amber K, Ackermann Ronald T, Kan Kristin, Huang Lynn, Raval Mehul V
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
JAMA Netw Open. 2025 Mar 3;8(3):e251533. doi: 10.1001/jamanetworkopen.2025.1533.
Potentially preventable hospitalization rates are widely endorsed quality indicators that have been used to evaluate the impact of policies on access to high-quality primary and ambulatory care for children. Although potentially preventable hospitalization rates have been decreasing, little is known about how these trends are associated with the exclusive reliance on inpatient data, which omit observation status, a common designation for pediatric hospital stays.
To assess the implications of omitting observation stay data on potentially preventable hospitalization rate calculations over time.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cross-sectional study, inpatient and observation stays for patients aged 6 to 17 years related to pediatric ambulatory care sensitive conditions (ACSCs), were identified from the Healthcare Cost and Utilization Project state-specific databases from Georgia, Iowa, Maryland, Nebraska, and Vermont, 2010 to 2019, and from Wisconsin, 2012 to 2019. The units of analysis include an overall aggregate level, state level, and county level. Data were analyzed from February to November 2024.
The main outcome was the pediatric quality indicator overall composite of potentially preventable hospitalization rates (hereafter the composite hospitalization rate) and was calculated using inpatient-only and combined (ie, inpatient and observation) hospital stay data per 100 000 children.
Among a total of 64 846 identified hospital stays (median [IQR] age, 10 [8-14] years for inpatient stays and 10 [7-13] for observation stays; 32 733 [50.5%] male; 573 [0.9%] Asian or Pacific Islander, 20 042 [30.9%] Black, 3413 [5.3%] Hispanic, 168 [0.3%] American Indian or Alaska Native, 22 970 [35.4%] White, and 1842 [2.8%] Other), 22 275 (34.4%) were observation stays. The use of observation stays grew from 2090 of 6923 stays (30.2%) in 2010 to 2525 of 5531 stays (45.7%) in 2019. When using inpatient-only data, the overall aggregate-level composite hospitalization rate per 100 000 children was 141.7 in 2010 and decreased to 71.0 in 2019, and the annual percentage change was -6.8% (95% CI, -6.8% to -6.8%; P < .001). When using combined data, the composite hospitalization rate was 203.0 in 2010 and 130.7 in 2019, respectively, with an annual percentage change of -4.5% (95% CI, -4.5% to -4.5%; P < .001). Most state-level and county-level composite hospitalization rates exhibited declining trends when using inpatient-only data. After combining observation stay data, the declines were attenuated or even reversed in some cases.
Decreases in the composite hospitalization rate for pediatric ACSCs were associated with the shifting of patient status from inpatient to observation stays. These findings emphasize the need for standardized reporting and inclusion of observation stay data to support disease surveillance, policy evaluation, and decision-making.
潜在可预防住院率是广泛认可的质量指标，已被用于评估政策对儿童获得高质量初级和门诊医疗服务的影响。尽管潜在可预防住院率一直在下降，但对于这些趋势如何与仅依赖住院数据相关联却知之甚少，因为住院数据遗漏了观察状态，而观察状态是儿科住院的常见指定方式。
评估随着时间推移，遗漏观察住院数据对潜在可预防住院率计算的影响。
设计、设置和参与者：在这项回顾性横断面研究中，从佐治亚州、爱荷华州、马里兰州、内布拉斯加州和佛蒙特州2010年至2019年以及威斯康星州2012年至2019年的医疗成本和利用项目特定州数据库中，识别出与儿科门诊医疗敏感疾病（ACSCs）相关的6至17岁患者的住院和观察住院情况。分析单位包括总体汇总水平、州水平和县水平。数据于2024年2月至11月进行分析。
主要结果是潜在可预防住院率的儿科质量指标总体综合指标（以下简称综合住院率），并使用每10万名儿童的仅住院和综合（即住院和观察）住院数据进行计算。
在总共64846例已识别的住院病例中（住院病例的年龄中位数[四分位间距]为10[8 - 14]岁，观察住院病例为10[7 - 13]岁；男性32733例[50.5%]；亚洲或太平洋岛民573例[0.9%]，黑人20042例[30.9%]，西班牙裔3413例[5.3%]，美洲印第安人或阿拉斯加原住民168例[0.3%]，白人22970例[35.4%]，其他1842例[2.8%]），22275例（34.4%）为观察住院病例。观察住院病例的使用比例从2010年6923例中的2090例（30.2%）增长到2019年5531例中的2525例（45.7%）。当仅使用住院数据时，每10万名儿童的总体汇总水平综合住院率在2010年为141.7，2019年降至71.0，年百分比变化为 - 6.8%（95%置信区间， - 6.8%至 - 6.8%；P < .001）。当使用综合数据时，2010年和2019年的综合住院率分别为203.0和130.7，年百分比变化为 - 4.5%（95%置信区间， - 4.5%至 - 4.5%；P < .001）。大多数州水平和县水平的综合住院率在仅使用住院数据时呈现下降趋势。在合并观察住院数据后，在某些情况下下降趋势减弱甚至逆转。
儿科ACSCs综合住院率的下降与患者状态从住院向观察住院的转变有关。这些发现强调了标准化报告以及纳入观察住院数据以支持疾病监测、政策评估和决策制定的必要性。
