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Published online November 2, 2009
PEDIATRICS (doi:10.1542/peds.2009-0473)
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Articles

Pediatric Hospital Adherence to the Standard of Care for Acute Gastroenteritis

Joel S. Tieder, MD, MPHa,b, Andrea Robertson, MPHa,c, Michelle M. Garrison, PhDa,c

aDepartment of Pediatrics, University of Washington, Seattle, Washington;
bDepartment of Pediatrics, Seattle Children's, Seattle, Washington; and
cCenter for Child Health, Behavior, and Development and Seattle Children's Hospital Research Institute, Seattle, Washington

Background Adherence to published care guidelines for the management of acute gastroenteritis (AGE) is unknown.

Objectives To evaluate the association of AGE guideline adherence with outcomes and resource use at pediatric hospitals.

Design/Methods We studied children aged 6 months to 6 years with an International Classification of Diseases, Ninth Edition (ICD-9) discharge code indicative of AGE and without comorbid conditions in the emergency department, observation setting, or hospital. Laboratory studies, antiemetic use, and antibiotic use were evaluated, and the length of stay, mean adjusted total charges, and readmission proportion were documented. Multiple analysis of variance determined if the variance of adjusted charges, length of stay, and diagnostic studies were hospital-related. A regression analysis determined the association between guideline adherence and outcomes.

Results There were a total of 188873 patients; 174594 (92.4%) were not admitted, and 14279 (7.6%) were admitted. There was substantial variation in resource use among hospitals. The mean adjusted total charge for all patients was $863 (SD: 1336). The mean adjusted total charge for nonadmitted patients was $591 (SD: 636). Individual hospitals contributed to the variance of mean length of stay, total adjusted charges, and use of diagnostic studies after controlling for covariates (P < .001). Guideline adherence was associated with a mean decrease in the average adjusted cost ($591) for nonadmitted patients of $296 (95% confidence interval: –399 to –193).

Conclusions Guideline-adherent hospitals demonstrated 50% lower charges for emergency department or observation patients with uncomplicated AGE without adversely affecting outcomes. Use of resources not routinely recommended by published AGE guidelines remains common in pediatric hospitals.

Key Words: variability • gastroenteritis • acute gastroenteritis • dehydration • vomiting • diarrhea • quality improvement • adherence

Abbreviations: PHIS, Pediatric Health Information System

Accepted Jun 16, 2009.


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