Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 441-447 (doi:10.1542/peds.2006-0484)
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ARTICLE

Variations in Management of Common Inpatient Pediatric Illnesses: Hospitalists and Community Pediatricians

Patrick H. Conway, MDa,b,c,d, Sarah Edwards, BAa,e, Erin R. Stucky, MDf, Vincent W. Chiang, MDa, Mary C. Ottolini, MD, MPHg and Christopher P. Landrigan, MD, MPHa,e

a Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
b Robert Wood Johnson Foundation Clinical Scholar Program
c Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
d Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
e Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
f Children's Hospital and Health Center, University of California, San Diego, School of Medicine, San Diego, California
g Children's National Medical Center, George Washington University School of Medicine, Washington, DC

OBJECTIVE. The goal was to test the hypothesis that pediatric hospitalists use evidence-based therapies and tests more consistently in the care of inpatients and use therapies and tests of unproven benefit less often, compared with community pediatricians.

METHODS. A national survey was administered to hospitalists and a random sample of community pediatricians. Hospitalists and community pediatricians reported their frequency of use of diagnostic tests and therapies, on 5-point Likert scales (ranging from never to almost always), for common inpatient pediatric illnesses. Responses were compared in univariate and multivariable logistic regression analyses controlling for gender, race, years out of residency, days spent attending per year, hospital practice type, and completion of fellowship/postgraduate training.

RESULTS. Two hundred thirteen pediatric hospitalists and 352 community pediatricians responded. In multivariable regression analyses, hospitalists were significantly more likely to report often or almost always using the following evidence-based therapies for asthma: albuterol and ipratropium in the first 24 hours of hospitalization. After the first urinary tract infection, hospitalists were more likely to report obtaining the recommended renal ultrasound and voiding cystourethrogram. Hospitalists were significantly more likely than community pediatricians to report rarely or never using the following therapies of unproven benefit: levalbuterol, inhaled steroid therapy, and oral steroid therapy for bronchiolitis; stool culture and rotavirus testing for gastroenteritis; and ipratropium after 24 hours of hospitalization for asthma.

CONCLUSION. Overall, in comparison with community pediatricians, hospitalists reported greater adherence to evidence-based therapies and tests in the care of hospitalized patients and less use of therapies and tests of unproven benefit.

Key Words: pediatrics • hospitalist • variability • variation • evidence-based medicine • health services research • inpatient

Abbreviations: AAP—American Academy of Pediatrics • AMA—American Medical Association • BMJ—British Medical Journal • SHM—Society of Hospital Medicine • UTI—urinary tract infection • OR—odds ratio • CI—confidence interval

Accepted Mar 22, 2006.




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