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PEDIATRICS Vol. 105 No. 4 April 2000, pp. 733-737

Pediatric Milliman and Robertson Length-of-Stay Criteria: Are They Realistic?

Received Nov 18, 1999; accepted Jan 7, 2000.

Marion R. Sills*, Dagger , Zhihuan J. Huang*, Cheng Shao*, Mark F. Guagliardo*, James M. Chamberlain*, and Jill G. Joseph*

From * Children's National Medical Center, Washington, DC; and Dagger  Children's Hospital, Denver, Colorado.

Objective.  Guidelines for inpatient length of stay (LOS) have been developed by several groups; among the most widely applied are those published by Milliman and Robertson (M&R). Few published reports have examined the relationship of actual practice to such guidelines, none in pediatric populations. This study was designed to compare pediatric practice in a large and defined population to M&R LOS criteria.

Methods.  Administrative data from New York State in 1995 were used to examine LOS for discharges corresponding to 16 selected pediatric diagnoses for which M&R publishes guidelines. Outliers, defined as the 2% of discharges with the longest LOS, were eliminated. The distribution of LOS for each diagnosis was compared with M&R LOS guidelines.

Results.  In New York State during 1995, pediatric LOS was markedly divergent from M&R guidelines. In general, the percentage of discharges in excess of the criterion LOS was less for nonmandatory admissions (croup: 23%, gastroenteritis: 44%, and pneumonia: 48%) than for those requiring surgery (uncomplicated appendectomy: 67%, pyloromyotomy: 62%, and major but noncritical burns: 64%) or prolonged treatment with antibiotics (bacterial meningitis: 91% and osteomyelitis: 86%).

Conclusions.  In New York State during 1995, LOS for selected pediatric conditions was generally in excess of published M&R guidelines. This raises concern about the potential effects of such guidelines on both patients and the hospitals caring for them. While endorsing the need for cost-effective practice, we call attention to the methods used to develop and validate guidelines.length of stay, pediatrics, managed health care, administrative data, practice guidelines. .


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