Tags

Type your tag names separated by a space and hit enter

Variation in resource use and readmission for diabetic ketoacidosis in children's hospitals.
Pediatrics. 2013 Aug; 132(2):229-36.Ped

Abstract

OBJECTIVE

We sought to characterize variation in hospital resource utilization and readmission for diabetic ketoacidosis (DKA) across US children's hospitals.

METHODS

The study sample included a retrospective cohort of children aged 2 to 18 years with a diagnosis of DKA at 38 children's hospitals between 2004 and 2009. The main outcomes were resource utilization as determined by total standardized cost per hospitalization, overall and non-ICU length of stay (LOS), and readmission for DKA within 30 and 365 days.

RESULTS

There were 24,890 DKA admissions, and 20.3% of these were readmissions within 1 year. The mean hospital-level total standardized cost was $7142 (range $4125-$11,916). The mean hospital-level LOS was 2.5 days (1.5-3.7), and the non-ICU portion was 1.9 days (0.7-2.7). The mean hospital-level readmission within 365 days was 18.7% (6.5%-41.1%) and within 30 days was 2.5% (0.0%-7.1%). Hospital bed days overall, and in particular the non-ICU portion, accounted for the majority of the total standardized cost per hospitalization (overall 57%; non-ICU 36%) and explained most of the variation in resource use. Even after adjusting for difference in patient characteristics across hospitals, widespread differences existed across hospitals in total standardized cost, LOS, and readmission rates (P < .001).

CONCLUSIONS

Readmission for DKA within a year of hospitalization is common. US children's hospitals vary widely in resource use, hospital LOS, and readmission rates for patients with DKA. Our study highlights the need for additional research to understand these differences and to identify the most cost-effective strategies for managing diabetes across the continuum of care.

Authors+Show Affiliations

Division of Inpatient Medicine, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington 98105, USA. joel.tieder@seattlechildrens.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23878044

Citation

Tieder, Joel S., et al. "Variation in Resource Use and Readmission for Diabetic Ketoacidosis in Children's Hospitals." Pediatrics, vol. 132, no. 2, 2013, pp. 229-36.
Tieder JS, McLeod L, Keren R, et al. Variation in resource use and readmission for diabetic ketoacidosis in children's hospitals. Pediatrics. 2013;132(2):229-36.
Tieder, J. S., McLeod, L., Keren, R., Luan, X., Localio, R., Mahant, S., Malik, F., Shah, S. S., Wilson, K. M., & Srivastava, R. (2013). Variation in resource use and readmission for diabetic ketoacidosis in children's hospitals. Pediatrics, 132(2), 229-36. https://doi.org/10.1542/peds.2013-0359
Tieder JS, et al. Variation in Resource Use and Readmission for Diabetic Ketoacidosis in Children's Hospitals. Pediatrics. 2013;132(2):229-36. PubMed PMID: 23878044.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variation in resource use and readmission for diabetic ketoacidosis in children's hospitals. AU - Tieder,Joel S, AU - McLeod,Lisa, AU - Keren,Ron, AU - Luan,Xianqun, AU - Localio,Russell, AU - Mahant,Sanjay, AU - Malik,Faisal, AU - Shah,Samir S, AU - Wilson,Karen M, AU - Srivastava,Rajendu, AU - ,, Y1 - 2013/07/22/ PY - 2013/7/24/entrez PY - 2013/7/24/pubmed PY - 2013/10/18/medline KW - DKA KW - Pediatric Research in Inpatient Settings (PRIS) network KW - diabetic ketoacidosis KW - hospitalist KW - readmission KW - type 1 diabetes mellitus SP - 229 EP - 36 JF - Pediatrics JO - Pediatrics VL - 132 IS - 2 N2 - OBJECTIVE: We sought to characterize variation in hospital resource utilization and readmission for diabetic ketoacidosis (DKA) across US children's hospitals. METHODS: The study sample included a retrospective cohort of children aged 2 to 18 years with a diagnosis of DKA at 38 children's hospitals between 2004 and 2009. The main outcomes were resource utilization as determined by total standardized cost per hospitalization, overall and non-ICU length of stay (LOS), and readmission for DKA within 30 and 365 days. RESULTS: There were 24,890 DKA admissions, and 20.3% of these were readmissions within 1 year. The mean hospital-level total standardized cost was $7142 (range $4125-$11,916). The mean hospital-level LOS was 2.5 days (1.5-3.7), and the non-ICU portion was 1.9 days (0.7-2.7). The mean hospital-level readmission within 365 days was 18.7% (6.5%-41.1%) and within 30 days was 2.5% (0.0%-7.1%). Hospital bed days overall, and in particular the non-ICU portion, accounted for the majority of the total standardized cost per hospitalization (overall 57%; non-ICU 36%) and explained most of the variation in resource use. Even after adjusting for difference in patient characteristics across hospitals, widespread differences existed across hospitals in total standardized cost, LOS, and readmission rates (P < .001). CONCLUSIONS: Readmission for DKA within a year of hospitalization is common. US children's hospitals vary widely in resource use, hospital LOS, and readmission rates for patients with DKA. Our study highlights the need for additional research to understand these differences and to identify the most cost-effective strategies for managing diabetes across the continuum of care. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/23878044/Variation_in_resource_use_and_readmission_for_diabetic_ketoacidosis_in_children's_hospitals_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=23878044 DB - PRIME DP - Unbound Medicine ER -