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Use of prolonged travel to improve pediatric risk-adjustment models

Scott A Lorch1, Jeffrey H Silber, Orit Even-Shoshan

  • 1Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. lorch@email.chop.edu

Health Services Research
|February 12, 2009
PubMed

Insights

Travel distance and time significantly impact pediatric hospital outcomes. Accounting for travel variables in risk adjustment improves comparisons of hospital quality, especially for children's hospitals.

Area of Science:

  • Healthcare outcomes research
  • Pediatric health services research
  • Health informatics

Background:

  • Previous studies reported variations in length of stay (LOS), readmission rates, and mortality for pediatric patients treated at children's hospitals versus other hospital types.
  • These differences were not fully explained by traditional risk-adjustment models.

Purpose of the Study:

  • To investigate if travel variables can account for previously observed disparities in pediatric patient outcomes.
  • To assess the impact of travel distance and time on length of stay, readmission, and mortality.
  • To improve the accuracy of hospital quality assessments by incorporating travel factors.

Main Methods:

  • Analysis of Pennsylvania hospital discharge data (1996-1998).
  • Creation of a cohort of 51,855 children (aged 1-17) with common pediatric conditions.
  • Development of regression models to compare outcomes (LOS, readmission, death) between children's and other hospitals, including travel variables alongside traditional illness severity measures.

Main Results:

  • Without travel variables, longer travel distances to children's or rural hospitals correlated with longer adjusted LOS and higher readmission rates.
  • Incorporating geocoded travel time or nongeocoded travel distance significantly reduced adjusted LOS, readmission rates, and mortality rates for children's and rural hospitals compared to other facilities.

Conclusions:

  • Travel variables are crucial for accurate risk adjustment in pediatric healthcare.
  • Adding travel metrics to severity adjustment models can mitigate systematic differences between hospitals.
  • This approach enhances the evaluation of individual hospital performance in pediatric care.
Abstract

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