Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity
| Autor: | Jay G. Berry, Elizabeth Casto, Matthew Hall, Ricardo A. Mosquera, Christian D. Pulcini, Paul J. Chung, Jonathan Rodean, Ryan J. Coller, Deborah E. Linares, Elizabeth R. Alpern |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Chronic condition medicine.medical_specialty Adolescent Patient demographics Young Adult 03 medical and health sciences Health services 0302 clinical medicine 030225 pediatrics Humans Medicine 030212 general & internal medicine Child Retrospective Studies business.industry Infant Newborn Infant Multimorbidity Retrospective cohort study Emergency department Hospitals Pediatric United States Hospitalization Child Preschool Chronic Disease Pediatrics Perinatology and Child Health Hospital admission Emergency medicine Linear Models Female Emergency Service Hospital business |
| Zdroj: | The Journal of Pediatrics. 214:113-120.e1 |
| ISSN: | 0022-3476 |
| DOI: | 10.1016/j.jpeds.2019.07.034 |
| Popis: | To evaluate factors associated with admission from emergency department (ED) encounters for children with medical complexity (CMC) and to quantify the hospital admission rate as well as variation in adjusted hospital admission rates across EDs.Retrospective study of 271 806 visits to 37 EDs in freestanding children's hospitals from January 1, 2014, to June 30, 2017, for patients of all ages with a complex chronic condition. Associations between patient demographic, clinical, and health services characteristics and the likelihood of hospital admission were identified using generalized linear models, which were then used to calculate adjusted hospital admission rates.Hospital admission occurred with 25.7% of ED visits. Characteristics with the greatest aOR of hospitalization were ≥3 compared with 0 prior hospitalizations in 365 days (4.7; 95% CI, 4.5-4.9), ED arrival overnight compared with during workday 3.2 (95% CI, 3.1-3.3)], and ≥6 vs 0-1 chronic conditions (1.6; 95% CI, 1.5-1.6). Adjusted hospital admission rates varied significantly (P .001) across EDs (21.1% [10th percentile]) and 30.0% [90th percentile]). Significant variation remained when excluding low-intensity ED visits, excluding hospitalizations requiring surgery and/or intensive care, or restricting the cohort to overnight ED arrival and to children with ≥3 prior hospitalizations.CMC are frequently admitted from the ED. Substantial variation in CMC hospital admission rates across EDs exists after case-mix adjustment. |
| Databáze: | OpenAIRE |
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