Asthma and bronchiolitis are the most frequent causes of hospital admissions among children in the United States. Pediatric hospitalists focusing on process improvement are well positioned to optimize resource utilization for common respiratory disorders.
The objectives were: (1) to compare length of stay (LOS) and 30‐day emergency department (ED) return visits, readmission, and mortality rates among children hospitalized for asthma and bronchiolitis before and after the implementation of a pediatric hospital medicine (PHM) program; (2) to contrast our results with weighted national estimates; (3) to estimate the potential impact of PHM programs on hospital charges at the local and national levels. The setting was a 120‐bed, inner‐city academic medical center, the Children's Hospital at Montefiore (CHAM), Bronx, New York. Data were extracted by selecting all ICD‐9‐CM admission codes for asthma and bronchiolitis (<18 and <4 years old, respectively), using unidentified electronic health record data by means of the Clinical Looking Glass™ (an interactive analytic tool to access clinical and administrative hospital data) and a national database: the Kids’ Inpatient Database (KID) 2006, Healthcare Cost and Utilization Project, AHRQ. No children were excluded. The retrospective before‐and‐after QI project was a 2‐group comparison. Group 1 was 12‐month historical control before July 1, 2007: traditional resident‐attending team. Group 2 was the 40‐month period after the implementation of a PHM program: the resident–PA–hospitalist team. The cross‐sectional study used a national database, KID 2006, with data from both children's and all hospitals in the United States. Descriptive statistics, percentile and cumulative percent curve, and 2‐group comparisons were used to test for difference in each group's curve (log‐rank Mantel‐Haenszel).
LOS for asthma and bronchiolitis decreased significantly during the 40‐month PHM program implementation period (Table 1). There were no significant differences in 30‐day ED return‐visits, readmission, or mortality rates. Estimated hospital‐bed days saved at CHAM were 378/year (estimated savings/year = $943,866). National database benchmarking—PHM resource utilization compared favorably against national data.
The introduction of a PHM program focusing on process improvement was associated with decreased LOS for asthma and bronchiolitis without significant adverse outcomes. To our knowledge, this is the first study to demonstrate such an effect in an inner‐city academic setting. Given the frequency of these conditions, a 12%–15% reduction in LOS can potentially impact resource utilization nationwide and decrease the yearly “national bill” by approximately $350 million. Future studies should assess the specific organizational characteristics of evolving PHM models that may influence patient outcomes and resource utilization.
N. Esteban‐Cruciani ‐ none; J. Montejo ‐ none; G. Azzarone ‐ none; L. Douglas ‐ none; S. Liewehr ‐ none; J. Nazif ‐ none; K. O’Connor ‐ none; H. Rhim ‐ none; A. Silver ‐ none; N. Litman ‐ none
To cite this abstract:Esteban‐Cruciani N, Montejo J, Azzarone G, Douglas L, Liewehr S, Nazif J, O’Connor K, Rhim H, Silver A, Litman N. Impact of a Pediatric Hospital Medicine Program on Resource Utilization for Children with Respiratory Disorders. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 45. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/impact-of-a-pediatric-hospital-medicine-program-on-resource-utilization-for-children-with-respiratory-disorders/. Accessed April 1, 2020.