| Abstrakt: |
Introduction: With annual costs in excess of $1.4 billion and accounting for 18 percent of hospitalizations involving infants, bronchiolitis has a significant impact on the U.S. healthcare system. Although previous studies have demonstrated higher costs and increased procedures without improved quality for pediatric bronchiolitis inpatients in the urban setting, no study has explored the pediatric bronchiolitis population in emergency department (ED) settings. This study aims to fill this gap by assessing the impact of emergency department setting (rural versus urban) on cost and quality for pediatric patients presenting with bronchiolitis secondary to respiratory syncytial virus (RSV). Methods: Using the Agency for Healthcare Research and Quality (AHRQ) 2013 National Emergency Department Sample (NEDS), this study examined hospitalized children, age less than 18, within a primary diagnosis of acute bronchiolitis due to RSV (ICD-9-CM 466.11). Charge information, clinical and demographic characteristics were compared between urban and rural emergency department locations. Weighted statistical analysis (using STATA 12.1) utilized the syv: function for sample data and the adjusted Wald tests for significance. Institutional Review Board approval was obtained. Results: The weighted sample of 8,495 observations (40,913 pediatric patients) with bronchiolitis had a mean age of 0.47 years with 44.8 percent female. 21.4 percent of the sample population was seen in the rural setting versus 78.6 percent in the urban setting. In comparing the rural setting (RS) versus urban setting (U.S.), results were as follows: Age (RS: 0.59 vs. U.S.: 0.44, p<0.001), Female (RS: 45.3 vs. U.S.: 44.6 percent, p=0.423), ED procedures (RS: 0.21 vs. U.S.: 0.16, p=0.002), Mortality (RS: 0.02 vs. U.S.: 0.01 percent, p=0.624), admissions from ED (RS: 23.2 vs. U.S.: 42.0 percent, p<0.001) and ED charges (RS: $1,695 vs. U.S.: $2,165, p<0.001). Conclusions: This study found that pediatric patients presenting to the emergency department with bronchiolitis secondary to RSV had no statistical difference in mortality rates based on setting. Rural patients had more procedures performed as an ED patient while urban patients were more often admitted and had higher overall ED charges. These findings suggest that rural pediatric patients may receive more cost-effective care, as they undergo more procedures as an ED patient versus being admitted without any impact on mortality. [ABSTRACT FROM AUTHOR] |
