Effect of practice variation on resource utilization in infants hospitalized for viral lower respiratory illness

Objective. Hospital care for children with viral lower respiratory illness (VLRI) is highly variable, and its relationship to severity and impact on o utcome is unclear. Using the Pediatric Comprehensive Severity Index, we ana lyzed the correlation of institutional practice variation with severity and resource utilization in 10 children's medical centers. Methods. Demographics, clinical information, laboratory results, interventi ons, and outcomes were extracted from the charts of consecutive infants wit h VLRI from 10 children's medical centers. Pediatric Component of the Compr ehensive Severity Index scoring was performed at admission and at maximum d uring hospitalization. The correlation of patient variables, interventions, and resource utilization at the patient level was compared with their corr elation at the aggregate institutional level. Results. Of 601 patients, 1 died, 6 were discharged to home health care, 4 were discharged to rehabilitative care, and 2 were discharged to chronic nu rsing care. Individual patient admission severity score correlated positive ly with patient hospital costs (r = 0.48), but institutional average patien t severity was negatively correlated with average institutional costs (r = -0.26). Maximal severity score correlated well with costs (r = 0.66) and le ngth of stay (LOS; r = 0.64) at the patient level but poorly at the institu tional level (r = 0.07 costs; r = 0.40 LOS). The institutional intensity of therapy was negatively correlated with admission severity (r = -0.03) but strongly correlated with costs (r = 0.84) and LOS (r = 0.83). Conclusions. Institutional differences in care practices for children with VLRI were not explained by differences in patient severity and did not affe ct the children's recovery but correlated significantly with hospital costs and LOS.