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Article
September 2011

Patient Volume and Quality of Care for Young Children Hospitalized With Acute Gastroenteritis

Author Affiliations

Author Affiliations: Department of Pediatrics (Drs McLeod and Keren) and Center for Pediatric Clinical Effectiveness (Drs Dai and Keren), Children's Hospital of Philadelphia, and Department for Biostatistics and Epidemiology (Drs French and Localio) and Leonard Davis Institute of Health Economics (Dr French), University of Pennsylvania, Philadelphia.

Arch Pediatr Adolesc Med. 2011;165(9):857-863. doi:10.1001/archpediatrics.2011.132
Abstract

Objective  To explore the relationship between the volume of children admitted to the hospital with acute gastroenteritis and adherence to recommended quality indicators.

Design  Retrospective cohort study.

Setting  Premier Perspective clinical and financial information systems database (Premier Inc, Charlotte, North Carolina).

Participants  A total of 12 604 otherwise healthy children aged 3 months to 10 years hospitalized between January 1, 2007, and December 31, 2009, at 280 US hospitals with International Classification of Diseases, Ninth Revision diagnosis codes indicating acute gastroenteritis.

Main Exposure  Volume of hospital admissions per year of children with acute gastroenteritis.

Main Outcome Measures  Quality indicators for overuse and misuse of care in the management of acute gastroenteritis based on nationally published guidelines. These include blood testing, stool studies, use of antibiotics, and use of nonrecommended antiemetic or antidiarrheal medications (hereafter referred to as nonrecommended medications).

Results  Selected blood, stool, and rotavirus tests (overuse indicators) were performed in 85%, 46%, and 56% of children, respectively. Six percent of children received nonrecommended medications, and 26% received antibiotics (misuse indicators). Higher volumes of hospital admission for acute gastroenteritis were associated with less use of blood tests (odds ratio [OR], 0.67 [95% confidence interval {CI}, 0.50-0.89]), nonrecommended medications (OR, 0.84 [95% CI, 0.76-0.93]), and antibiotics (OR, 0.93 [95% CI, 0.86-0.99]). Children admitted to hospitals in the 25th vs 75th percentile of patient volume had a 10%, 30%, and 10% increased chance of having blood tests, nonrecommended medications, and antibiotics ordered, respectively.

Conclusions  In a nationally representative sample of hospitals that care for children with acute gastroenteritis, higher patient volumes were associated with greater adherence to established quality indicators. Further investigation is needed to identify the hospital characteristics driving the volume-quality relationship for this common pediatric condition.

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