Impact of a Health Maintenance Organization Hospitalist System in Academic Pediatrics

BACKGROUND:Inpatient hyperglycemia in adult patients with and without a history of diabetes is a predictor of poor clinical outcome. No previous studies, however, have examined the association of hyperglycemia and clinical outcome in children admitted to a community pediatric hospital.METHODS:The study was a retrospective observational cohort of pediatric patients admitted to a community children's hospital from January 2004 to August 2004. Medical records of 903 consecutive children admitted to critical and non–critical care areas were reviewed. Of them, 342 patients (38%) had no blood glucose measurements during their hospital stay. In the remaining patients, we determined the prevalence of hyperglycemia and examined the association of hyperglycemia with clinical outcome.RESULTS:A total of 406 patients (75%) had an admission blood glucose ≤120 mg/dL (mean ± SEM 98 ± 1 mg/dL), 103 children (19%) had an admission blood glucose level of 121–179 mg/dL (mean 143 ± 2 mg/dL), and 32 patients (5.9%) had a blood glucose level ≥180 mg/dL (mean 260 ± 18 mg/dL). Seventeen patients (13%) had a known history of diabetes prior to admission. Children with hyperglycemia were more likely to be admitted to the ICU (P < .001) and had a longer length of ICU stay (P < .001), but admission hyperglycemia was not associated with longer hospital stay or higher hospital mortality.CONCLUSIONS:Hyperglycemia is present in one‐fourth of children admitted to the hospital, most of them without a history of diabetes prior to admission. Hyperglycemia was associated with a greater need for ICU care and longer ICU stay but not with increased in‐hospital mortality. Journal of Hospital Medicine 2008;3:212–217. © 2008 Society of Hospital Medicine.

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

“…Death is a rare occurrence in pediatric ward settings, and the seven studies conducted to date comparing pediatric hospitalist and traditional systems have been universally underpowered to detect differences in mortality. 9,[12][13][14][15][16][17][18] There is a need to better understand care processes as a first step in understanding and improving quality of care in hospitalist systems. 19 The Pediatric Research in Inpatient Settings (PRIS) Network was formed to improve the quality of care for hospitalized children through collaborative clinical research.…”

Section: Design and Measurementsmentioning

confidence: 99%

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

Landrigan

Conway

Stucky

et al. 2008

Self Cite

BACKGROUND:Undesirable practice variation remains a major concern with the quality of the healthcare system. While care in pediatric hospitalist systems has been demonstrated to be efficient, neither the quality of care nor determinants of variation in pediatric hospitalist systems are well understood.OBJECTIVE:To measure variation in pediatric hospitalists' reported use of common inpatient therapies, and to test the hypothesis that variation in reported use of proven therapies is lower than variation in reported use of unproven therapies.DESIGN AND MEASUREMENTS:We conducted a survey of pediatric hospitalists in the US and Canada. Respondents reported their frequency of using 14 therapies in the management of common conditions. Each therapy was determined to be of proven or unproven effectiveness using published critical appraisals. Variation in reported use of proven and unproven therapies was compared.RESULTS:67% (213/320) of surveyed individuals participated. Little variability existed in reported use of albuterol and corticosteroids in asthma (4‐6% of respondents reported not often using them) and systemic dexamethasone in bronchiolitis (12% of respondents reported using it more than rarely). Moderate to high variation existed in reported use of all other therapies studied. Variation in reported use of proven therapies was significantly less than variation in reported use of unproven therapies (15.5 ± 12.5% vs. 44.6 ± 20.5%).CONCLUSIONS:Substantial variation exists in hospitalists' reported management of common pediatric conditions. Variation is significantly lower for strongly evidence‐based therapies. To decrease undesirable variation in care, a stronger evidence base for inpatient pediatric care must be built. Journal of Hospital Medicine 2008;3:292–298. © 2008 Society of Hospital Medicine.

“…Bellet and Whitaker, 13 Landrigan et al, 14 Ogershok et al, 16 and Bekmezian et al 18 reported reductions in cost for all patients varying from 9% to 29%, while Wells et al 15 and Srivastava et al 17 found reductions in cost only for patients with certain diagnoses. Srivastava et al 17 analyzed 1970 patients, admitted with primary diagnoses of asthma, dehydration, or viral illness, over a 5-year period from 1993 to 1997.…”

Section: No Difference In Readmission Ratesmentioning

confidence: 99%

“…The studies by Dwight et al, 12 Bellet and Whitaker, 13 Landrigan et al, 14 Ogershok et al, 16 Bekmezian et al, 18 and Boyd et al 21 examined mortality and readmission rate. None of these studies reported differences in mortality rate, though none were powered to do so.…”

Section: Other Quality Measuresmentioning

confidence: 99%

Pediatric hospitalist systems versus traditional models of care: Effect on quality and cost outcomes

Mussman

Conway

2011