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Institutional variation in ordering complete blood counts for children hospitalized with bronchiolitis
Beth A Tarini1, Michelle M Garrison, Dimitri A Christakis
1Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan, USA. btarini@umich.edu
Insights
Complete blood counts (CBCs) are frequently ordered for infants with bronchiolitis, despite limited evidence. This practice varies widely across hospitals and is linked to higher healthcare charges.
Area of Science:
- Pediatric hospital medicine
- Healthcare quality and utilization
Background:
- Limited evidence supports diagnostic testing, including complete blood counts (CBCs), for infants with bronchiolitis.
- The frequency of CBC ordering in this population remains largely unknown.
Purpose of the Study:
- To assess institutional variation in initial and repeat CBC ordering for hospitalized infants with bronchiolitis.
- To investigate the correlation between the proportion of admissions with CBCs and mean hospital charges.
Main Methods:
- Analysis of the Pediatric Health Information System database from 30 U.S. children's hospitals.
- Inclusion criteria: infants (<12 months) with primary diagnosis of bronchiolitis.
- Statistical methods included multivariate ANOVA and stratified logistic regression to analyze CBC ordering patterns and hospital charges.
Main Results:
- Out of 17,397 infants, 48.2% received at least one CBC, and 7.8% received more than one.
- Significant institutional variability was observed in both initial (23.2%-70.2%) and repeat (0%-18.6%) CBC ordering.
- Hospitals with higher CBC ordering rates showed significantly higher mean hospital stay charges.
Conclusions:
- Ordering of CBCs in infants with bronchiolitis exhibits considerable institutional variation.
- The practice is associated with increased hospital charges, suggesting potential for cost savings.
- Further research is needed to understand the drivers of this variation and its downstream implications.
Background:
In the evaluation of infants with bronchiolitis there is little evidence to support the use of diagnostic testing, particularly complete blood counts (CBCs). However, the extent to which CBCs are ordered in the evaluation of infants with bronchiolitis is unknown.
Objectives:
(1) To determine institutional variability in ordering of initial and repeat CBCs in infants hospitalized with bronchiolitis; (2) to examine the relationship between proportion of admissions with CBCs and mean hospital charges.
Methods:
We analyzed the Pediatric Health Information System database, which contains demographic and diagnostic data from 30 U.S. children's hospitals. We restricted our analysis to children less than 12 months old with a primary discharge diagnosis of bronchiolitis and an APR-DRG of bronchiolitis/asthma. We performed multivariate ANOVA to examine variability in initial and repeat CBC ordering across hospitals, controlling for potential confounders. We used stratified logistic regression to determine which factors were associated with repeat CBCs. We examined the relationship between proportion of admissions with CBCs and mean hospital charges using t tests.
Results:
17,397 children were included in the analysis, and 48.2% had at least 1 CBC, whereas 7.8% had more than 1 CBC. The proportion of admissions with initial (23.2%-70.2%) and repeat (0%-18.6%) CBCs varied significantly across hospitals. Compared to those hospitals with the lowest proportion of admissions with CBCs, hospitals with higher proportions of CBCs had significantly higher mean hospital stay charges.
Conclusions:
Given the potential downstream medical and financial consequences associated with CBC ordering in evaluation of infants with bronchiolitis, explanations for institutional variation warrant exploration.
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