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Research Letter
May 2015

Direct Admission to Hospitals Among Children in the United States

Author Affiliations
  • 1Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts Medical Center, Boston, Massachusetts
  • 2Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
  • 3Department of Medicine, Tufts Medical Center, Boston, Massachusetts
  • 4Division of General Medicine, Baystate Medical Center, Springfield, Massachusetts
  • 5School of Public Health and Health Sciences, University of Massachusetts, Amherst
JAMA Pediatr. 2015;169(5):500-502. doi:10.1001/jamapediatrics.2014.3702

While a decade of research and policy interventions has begun to transform hospital discharge processes, research focused on hospital admissions is lacking. Emergency departments (EDs) are increasingly serving as portals of hospital admission, contributing to national concerns about ED volumes, wait times, and discontinuity of care.1 Despite this, there is a paucity of research examining other options for hospital admission.

Direct admission, defined as admission to a hospital without receiving care in the hospital’s ED, is 1 alternative. Although direct admission has potential benefits for patients and health care systems, little is known about its use or effectiveness. To our knowledge, only 1 study has examined outcomes associated with pediatric direct admissions and there are no national statistics about the characteristics of this admission approach.2 To address this gap, we used a nationally representative data set to determine pediatric direct admission rates, characteristics, and costs relative to admission through EDs and characterize variation in direct admission rates across diagnoses and hospitals.