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Variation in resource use and readmission for diabetic ketoacidosis in children's hospitals

Joel S Tieder1, Lisa McLeod, Ron Keren

  • 1Division of Inpatient Medicine, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington 98105, USA. joel.tieder@seattlechildrens.org

Pediatrics
|July 24, 2013
PubMed

Insights

Diabetic ketoacidosis (DKA) readmissions are common in children, with significant variations in hospital costs and length of stay (LOS) across US children's hospitals. Further research is needed to identify cost-effective diabetes management strategies.

Area of Science:

  • Pediatric Endocrinology
  • Healthcare Management
  • Health Services Research

Background:

  • Diabetic ketoacidosis (DKA) is a serious complication of diabetes in children.
  • Understanding variations in hospital resource utilization and readmission rates for DKA is crucial for improving patient outcomes and managing healthcare costs.

Purpose of the Study:

  • To characterize the variation in hospital resource utilization and readmission rates for diabetic ketoacidosis (DKA) among US children's hospitals.
  • To identify factors contributing to differences in cost, length of stay (LOS), and readmission for DKA.

Main Methods:

  • Retrospective cohort study of children aged 2-18 years diagnosed with DKA.
  • Data collected from 38 children's hospitals between 2004 and 2009.
  • Outcomes assessed: total standardized cost, overall and non-ICU length of stay (LOS), and 30- and 365-day DKA readmissions.

Main Results:

  • 24,890 DKA admissions analyzed; 20.3% were readmissions within one year.
  • Mean hospital costs varied significantly ($7142), as did LOS (2.5 days) and readmission rates (18.7% within 365 days).
  • Hospital bed days (overall and non-ICU) constituted the majority of costs and explained resource use variation; significant inter-hospital differences persisted after adjustment for patient characteristics.

Conclusions:

  • Readmission for DKA within a year is frequent in pediatric populations.
  • Substantial variability exists across US children's hospitals in resource use, LOS, and DKA readmission rates.
  • Further research is essential to understand these disparities and develop cost-effective diabetes management strategies across the care continuum.
Abstract

Keywords:
DKAPediatric Research in Inpatient Settings (PRIS) networkdiabetic ketoacidosishospitalistreadmissiontype 1 diabetes mellitus

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