VARIATIONS IN PEDIATRIC PNEUMONIA AND BRONCHITIS ASTHMA ADMISSION RATES - IS APPROPRIATENESS A FACTOR

Objective: To explore through a pilot study the relationship between a ppropriateness (medical necessity) and variations in pediatric hospita l admission rates across several communities in the Boston (Mass) area for two common pediatric conditions with extremely variable admission rates: pneumonia and bronchitis/asthma. Design: We identified five co mmunities in the greater Boston area with high, average, and below-ave rage ratios of observed to expected admissions for the study condition s. Diagnosis-specific, criteria-based utilization review instruments w ere developed by community-based pediatricians and applied by trained nurse reviewers to medical records. Admissions Studied: All admissions for pneumonia (diagnosis related group [DRG] 91) and bronchitis/asthm a (DRG 98) of study area residents younger than 18 years to participat ing hospitals during fiscal year 1986. Outcome Measures: For each area , we calculated age-adjusted admission rates, age-adjusted observed to expected ratios, and rates of inappropriate admissions. We tested the hypothesis that admission rates and inappropriateness rates were dire ctly related. Results: We deemed 9.4% of pneumonia admissions and 4.4% of bronchitis/asthma admissions inappropriate. Rates of inappropriate admissions were not significantly associated with admission rates in this local pilot study for either study condition at P<.05. However, i n one community both rates were high for both conditions. Feedback of findings to the key local hospital there resulted in sharp decreases i n admission rates for DRGs 91 and 98 in subsequent years. Conclusions: Our results suggest that higher pediatric admission rates may not be associated with higher rates of inappropriateness. Further research is needed, with a larger number of communities, to differentiate practic e patterns more precisely and explore patient and family preferences.