Smc. Payne et al., VARIATIONS IN PEDIATRIC PNEUMONIA AND BRONCHITIS ASTHMA ADMISSION RATES - IS APPROPRIATENESS A FACTOR, Archives of pediatrics & adolescent medicine, 149(2), 1995, pp. 162-169
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.