TY - JOUR PY - 2014// TI - Variation in emergency department admission rates in US children's hospitals JO - Pediatrics A1 - Bourgeois, Florence T. A1 - Monuteaux, Michael C. A1 - Stack, Anne M. A1 - Neuman, Mark I. SP - 539 EP - 545 VL - 134 IS - 3 N2 - 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.

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.

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.

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.

Language: en

LA - en SN - 0031-4005 UR - http://dx.doi.org/10.1542/peds.2014-1278 ID - ref1 ER -