LENGTH OF STAY FOR SPECIALIZED PEDIATRIC UROLOGIC CARE

Background: Pediatric urologic specialists have been excluded from man y recent managed care contracts because they are believed to be more e xpensive and of no better quality than general urologists in managing common urologic problems in children. We believed this to be inaccurat e. Objectives: To compare the length of stay at the University of Cali fornia, San Francisco Medical Center for 2 common pediatric urologic o perative procedures with data from other northern California hospitals and to document our results and patient satisfaction. Design: Retrosp ective analysis of HCIA statewide database (HCIA Inc, Orange, Conn). S etting: Northern California, 1995. Subjects: Children younger than 12 years undergoing surgery for repair of an obstruction of the ureterope lvic junction or vesicoureteral reflux. Main Outcome Measure: Length o f stay. Results: The length of stay in our hospital was similar to tha t observed in other hospitals in which other full-time pediatric urolo gic specialists practiced and was significantly less than that observe d in other northern California hospitals, even when adjusted for risk. In fact, a savings of 279 hospital days would have been realized if a ll patients had the same length of stay as that achieved at University of California, San Francisco Medical Center. In the 38 patients opera ted on at our center, there was uniform surgical success. Of the paren ts, 92% (11/12) were satisfied with their child's care and 92% (11/12) believed they received enough information to know what to expect and how to care for their child at home. There were no data available eval uating quality from other northern California hospitals for comparison . Conclusions: Our finding that actual and risk-adjusted length of sta y were shorter when patients were treated by full-time pediatric urolo gists, while excellent quality was maintained, suggests that these spe cialists achieve their results with more efficiency and lower resource utilization than do general urologists. The implication of these resu lts is that exclusive contracting that prevents patients from receivin g care from full-time specialists results in overuse of valuable resou rces and possibly reduced quality. If our results are generalizable, t hey have important implications for health care reform in the United S tates.