@article{ref1,
title="Variation in emergency department admission rates in US children's hospitals",
journal="Pediatrics",
year="2014",
author="Bourgeois, Florence T. and Monuteaux, Michael C. and Stack, Anne M. and Neuman, Mark I.",
volume="134",
number="3",
pages="539-545",
abstract="OBJECTIVE: To measure the hospital-level variation in admission rates for children receiving treatment of common pediatric illnesses across emergency departments (EDs) in US children's hospitals. <br><br>METHODS: We performed a multi-center cross sectional study of children presenting to the EDs of 35 pediatric tertiary-care hospitals participating in the Pediatric Health Information System (PHIS). Admission rates were calculated for visits occurring between January 1, 2009, and December 31, 2012, associated with 1 of 7 common conditions, and corrected to adjust for hospital-level severity of illness. Conditions were selected systematically based on frequency of visits and admission rates. <br><br>RESULTS: A total of 1 288 706 ED encounters (13.8% of all encounters) were associated with 1 of the 7 conditions of interest. After adjusting for hospital-level severity, the greatest variation in admission rates was observed for concussion (range 5%-72%), followed by pneumonia (19%-69%), and bronchiolitis (19%-65%). The least variation was found among patients presenting with seizures (7%-37%) and kidney and urinary tract infections (6%-37%). Although variability existed in disease-specific admission rates, certain hospitals had consistently higher, and others consistently lower, admission rates. <br><br>CONCLUSIONS: We observed greater than threefold variation in severity-adjusted admission rates for common pediatric conditions across US children's hospitals. Although local practices and hospital-level factors may partly explain this variation, our findings highlight the need for greater focus on the standardization of decisions regarding admission.<p /> <p>Language: en</p>",
language="en",
issn="0031-4005",
doi="10.1542/peds.2014-1278",
url="http://dx.doi.org/10.1542/peds.2014-1278"
}