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PEDIATRICS Vol. 108 No. 4 October 2001, pp. 851-855

Effect of Practice Variation on Resource Utilization in Infants Hospitalized for Viral Lower Respiratory Illness

Received Oct 24, 2000; accepted Feb 5, 2001.

Douglas F. Willson*, Susan D. HornDagger , J. Owen Hendleyparallel , Randall Smout§, and Julie Gassaway§

From the * University of Virginia Children's Medical Center, Charlottesville, Virginia; Dagger  Department of Medical Informatics, Institute for Clinical Outcomes Research, § International Severity Information Systems, Inc, Salt Lake City, Utah; and parallel  Division of Pediatric Infectious Disease, University of Virginia Children's Medical Center, Charlottesville, Virginia.

Objective.  Hospital care for children with viral lower respiratory illness (VLRI) is highly variable, and its relationship to severity and impact on outcome is unclear. Using the Pediatric Comprehensive Severity Index, we analyzed the correlation of institutional practice variation with severity and resource utilization in 10 children's medical centers.

Methods.  Demographics, clinical information, laboratory results, interventions, and outcomes were extracted from the charts of consecutive infants with VLRI from 10 children's medical centers. Pediatric Component of the Comprehensive Severity Index scoring was performed at admission and at maximum during hospitalization. The correlation of patient variables, interventions, and resource utilization at the patient level was compared with their correlation at the aggregate institutional level.

Results.  Of 601 patients, 1 died, 6 were discharged to home health care, 4 were discharged to rehabilitative care, and 2 were discharged to chronic nursing care. Individual patient admission severity score correlated positively with patient hospital costs (r = 0.48), but institutional average patient severity was negatively correlated with average institutional costs (r = -0.26). Maximal severity score correlated well with costs (r = 0.66) and length of stay (LOS; r = 0.64) at the patient level but poorly at the institutional level (r = 0.07 costs; r = 0.40 LOS). The institutional intensity of therapy was negatively correlated with admission severity (r = -0.03) but strongly correlated with costs (r = 0.84) and LOS (r = 0.83).

Conclusions.  Institutional differences in care practices for children with VLRI were not explained by differences in patient severity and did not affect the children's recovery but correlated significantly with hospital costs and LOS.  Key words:  respiratory syncytial virus, bronchiolitis, lower respiratory illness, practice variation, pediatric intensive care, intravascular catheters, Comprehensive Severity Index, severity scoring.




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