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Hospital and Community Characteristics Associated With Pediatric Direct Admission to Hospital
JoAnna K Leyenaar1, Meng-Shiou Shieh2, Tara Lagu3
1Section of Pediatric Hospital Medicine, Department of Pediatrics & The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Graduate Program in Clinical and Translational Science, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Mass.
Insights
Direct pediatric hospital admissions vary significantly between hospitals. While factors like emergency department (ED) volume and pediatrician workforce size influence rates, most variation remains unexplained, suggesting infrastructure improvements are needed.
Area of Science:
- Pediatric hospital administration
- Healthcare management
- Health services research
Background:
- Approximately 25% of pediatric hospitalizations are direct admissions, bypassing the emergency department (ED).
- Significant variability exists in direct admission rates across different hospitals.
- Previous research has not fully explored the factors contributing to this observed variation.
Purpose of the Study:
- To identify relationships between hospital and community factors and pediatric direct admission rates.
- To quantify the extent to which these factors explain variations in risk-adjusted direct admission rates.
- To inform strategies for optimizing pediatric direct admission processes.
Main Methods:
- Cross-sectional study utilizing national databases (Kids Inpatient Database, AHA Database, Area Health Resource File).
- Inclusion of pediatric medical hospitalizations across 26 states.
- Application of hierarchical generalized linear modeling to calculate risk-adjusted direct admission rates.
Main Results:
- Analysis included 211,458 pediatric hospitalizations from 933 hospitals; 20.2% were direct admissions.
- Hospital and community factors explained approximately 20% of the variance in risk-adjusted direct admission rates.
- Key factors influencing direct admission rates included ED volume (37%), pediatric hospitalization volume (27%), and pediatrician workforce size (12%).
Conclusions:
- While hospital and community characteristics are associated with pediatric direct admission rates, they do not account for the majority of rate variations.
- Findings highlight the need for hospitals to enhance infrastructure and communication systems to better support direct pediatric admissions.
- Opportunities exist for various hospital types to improve their direct admission protocols.
Objectives:
One quarter of pediatric hospitalizations begin as direct admissions, defined as hospitalization without receiving care in the hospital's emergency department (ED). Direct admission rates are highly variable across hospitals, yet previous studies have not examined reasons for this variation. We aimed to determine the relationships between hospital and community factors and pediatric direct admission rates, and to evaluate the degree to which these characteristics explain variation in risk-adjusted direct admission rates.
Methods:
We conducted a cross-sectional study of the Healthcare Cost and Utilization Project's Kids Inpatient Database, American Hospital Association Database, and Area Health Resource File, including children <18 years of age who were admitted for a medical hospitalization in states contributing data to all data sets. Using hierarchical generalized linear modeling, we generated risk-adjusted direct admission rates and used generalized linear models to assess the association of hospital and community characteristics with these risk-adjusted rates.
Results:
We included 211,458 children discharged from 933 hospitals and 26 states; 20.2% were admitted directly. One-fifth of the variance in risk-adjusted direct admission rates was attributed to observed hospital and community factors. The greatest proportion of this explained variance was related to ED volume (37%), volume of pediatric hospitalizations (27%), and size of the pediatrician workforce (12%).
Conclusions:
Direct admission rates were associated with several hospital and community characteristics, but the majority of variation in hospitals' direct admission rates was not explained by these factors. These findings suggest opportunities for diverse hospital types to develop the infrastructure and communication systems necessary to support pediatric direct admissions.
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