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Factors associated with variability in outcomes for children hospitalized with urinary tract infection
1Center for Health Care Quality and Division of Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. patrick.conway@cchmc.org
Insights
Hospital care for pediatric urinary tract infections (UTIs) varies significantly. Implementing clinical practice guidelines can reduce length of stay and costs for children with UTIs.
Area of Science:
- Pediatric Nephrology
- Healthcare Quality Improvement
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) are common in children, leading to hospitalization.
- Significant variability exists in the management and outcomes of pediatric UTI hospitalizations.
Purpose of the Study:
- To quantify variability in pediatric UTI hospitalization outcomes and care processes.
- To identify patient and hospital factors influencing these variations.
Main Methods:
- Retrospective cohort study of 20,892 children (1 month-12 years) hospitalized for UTI.
- Analysis of data from 25 children's hospitals (1999-2004).
- Measured outcomes: length-of-stay (LOS), cost, readmission, ICU admission, imaging rates (renal ultrasound, voiding cystourethrogram).
Main Results:
- Wide variation observed in LOS (2.1-5.0 days) and imaging rates (0.3%-72.9%) across hospitals.
- Older children had shorter LOS and less imaging; high-volume hospitals performed more imaging.
- Hospitals with more Medicaid patients had longer LOS and less imaging; those with UTI clinical guidelines had shorter LOS and lower costs.
Conclusions:
- Variability in pediatric UTI care presents opportunities for benchmarking and standardization.
- Clinical practice guidelines are associated with reduced LOS and costs, supporting their implementation for improved quality of care.
Objectives:
To describe the variability in outcomes and care processes for children hospitalized for urinary tract infection (UTI), and to identify patient and hospital factors that may account for variability.
Study Design:
Retrospective cohort of children 1 month to 12 years of age hospitalized for UTI at 25 children's hospitals from 1999 to 2004. We measured variability in length-of-stay (LOS), cost, readmission rate, intensive care unit admission, and performance of renal ultrasound and voiding cystourethrogram and identified patient and hospital factors associated with these outcomes.
Results:
The cohort included 20,892 children. There was significant variation in outcomes and processes of care across hospitals (eg, mean LOS, 2.1-5.0 days; patients with both imaging tests performed, 0.3%-72.9%). Older children had shorter LOS and were less likely to undergo imaging. Patients hospitalized at high volume hospitals were more likely to undergo imaging. Hospitals with high percentage of Medicaid patients had longer LOS and were less likely to perform imaging tests. Hospitals with a clinical practice guideline for UTI had shorter LOS and decreased costs per admission.
Conclusions:
The variability across hospitals may represent opportunities for benchmarking, standardization, and quality improvement. Decreased LOS and costs associated with clinical practice guidelines support their implementation.
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