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McDaniel CE, Hall M, Berry JG. Hospitalization Patterns for Rural-Residing Children from 2002 to 2017. Acad Pediatr 2024:S1876-2859(24)00291-2. [PMID: 39111620 DOI: 10.1016/j.acap.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 07/13/2024] [Accepted: 07/25/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE The closure of inpatient pediatric units within general hospitals has contributed to the regionalization of pediatric care. For children in rural areas, the distance traveled for hospitalization impacts the quality of care for children, the impact upon families, and the preparedness for disaster planning within rural communities. We assessed trends in location of hospitalization over time for rural-residing children. METHODS Using the Healthcare Cost and Utilization Project's State Inpatient Databases, we studied 256,947 hospitalizations for rural-residing children 0-17 years of age within eight states (CO, FL, KY, NC, NJ, NY, OR, WA) from 2002-2017. Level of rurality was defined by Rural-Urban Commuting Area Codes: micropolitan, small rural, and isolated rural. Birth, psychiatric, and surgical hospitalizations were excluded. Trends in number of hospitalizations by hospital location, interfacility transfer (IFT), and whether the hospital location was the same level of rurality as the patient's home residence were assessed with the Cochran-Armitage trend test. RESULTS From 2002 to 2017, hospitalizations for rural-residing children decreased by 52.7% (56,168 to 26,548) and IFTs increased from 6.7% to 26.5% (p<.001). The proportion of total hospitalizations within metropolitan areas for rural-residing children increased from 32.2% to 72.8% (p<.001). Local-area agreement between the patient's residence and hospital utilized decreased from 53.6% to 21.5% (p<.001). CONCLUSIONS Although overall hospitalizations for rural-residing children decreased, IFTs increased, and the proportion hospitalized in metropolitan areas increased. The impact of this shift in inpatient health services on efficiency and quality of care for rural-residing children needs further exploration.
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Affiliation(s)
- Corrie E McDaniel
- Department of Pediatrics, Division of Hospital Medicine, University of Washington; Seattle, Washington.
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Jay G Berry
- Complex Care, Division of General Pediatrics, Department of Pediatrics, Harvard Medical School and Boston Children's Hospital; Boston, Massachusetts
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2
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Ingram MC, Hu A, Lewit R, Arshad SA, Witte A, Keane OA, Dantes G, Mehl SC, Evans PT, Santore MT, Huang EY, Lopez ME, Tsao K, Van Arendonk K, Blakely ML, Raval MV. Improving Accuracy of Administrative Data for Perforated Appendicitis Classification. J Surg Res 2024; 299:120-128. [PMID: 38749315 DOI: 10.1016/j.jss.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/06/2024] [Accepted: 03/22/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Reliance on International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes may misclassify perforated appendicitis with resultant research, fiscal, and public health implications. We aimed to improve the accuracy of administrative data for perforated appendicitis classification relying on ICD-10-CM codes from 2015 to 2018. METHODS We conducted a retrospective study of randomly sampled patients aged ≤18 years diagnosed with acute appendicitis from eight children's hospitals. Patients were identified using the Pediatric Health Information System, and true perforation status was determined by medical record review. We developed two algorithms by leveraging Pediatric Health Information System data elements and data mining (DM) approaches. The two developed algorithm performance was compared against algorithms that exclusively relied on ICD-10-CM codes using area under the curve and other measures. RESULTS Of 1051 clinically validated encounters that were included, 383 (36.4%) patients were identified to have perforated appendicitis. The two algorithms developed using DM approaches primarily leveraged ICD-10-CM codes and length of stay. DM-developed algorithms had a significantly higher accuracy than algorithms relying exclusively on ICD-10-CM (P value < 0.01): sensitivity and specificity for DM-developed algorithms were 0.86-0.88 and 0.95-0.97, respectively, which were overall higher than algorithms that relied on only ICD-10-CM. CONCLUSIONS This study provides an algorithm that can improve the accuracy of perforated appendicitis classification using commonly available elements in administrative data. We recommend that this algorithm is used in future appendicitis classification to ensure valid reporting, hospital-level benchmarking, and fiscal or public health assessments.
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Affiliation(s)
- Martha-Conley Ingram
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Andrew Hu
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Ruth Lewit
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Seyed Arshia Arshad
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Amanda Witte
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Olivia A Keane
- Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Goeto Dantes
- Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Steven C Mehl
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Parker T Evans
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew T Santore
- Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Eunice Y Huang
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Monica E Lopez
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kuojen Tsao
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Kyle Van Arendonk
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Martin L Blakely
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Arar S, Hall M, Johnson K, Katragadda H, Martinez K, Dadwani A, Chen CN, Devarakonda A, Gribbons M, Challa L, Gupta AT, Patel A, Solomon C, Nunneley CE, Lee BC, Yu AG. Hospital costs and reimbursement for short-stay inpatient versus observation status hospitalizations for children with medical complexity. J Hosp Med 2024. [PMID: 38840249 DOI: 10.1002/jhm.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND There is a lack of uniformity across hospitals in applying inpatient versus observation status for short-stay (<48 h) pediatric hospitalizations, with negative financial implications associated with observation. Children with medical complexity (CMC) represent a growing population and incur high costs of care. The financial implications of inpatient and observation status for CMC have not been studied. OBJECTIVES To compare costs and reimbursement for short-stay hospitalizations for CMC by inpatient and observation status, overall and stratified by payor. METHODS We performed a cohort study of short-stay hospitalizations for CMC from 2016 to 2021 at 10 children's hospitals reporting reimbursement in the Pediatric Health Information System and Revenue Management Program. The primary outcome was the cost coverage ratio (CCR), defined as an encounter's reimbursement divided by the estimated cost. RESULTS There were 89,282 encounters included. The median costs per encounter were similar across observation ($5206, IQR $3604-$7484) and inpatient ($6547, IQR $4725-$9349) encounters. For government payors, the median CCR was 0.6 (IQR 0.2-0.9) for observation encounters and 1.2 (IQR 0.8-1.9) for inpatient. For nongovernment payors, the median CCR was 1.6 (IQR 1.3-1.9) for observation and 1.6 (IQR 1.4-2) for inpatient. Government reimbursement was associated with increased risk for financial loss (OR 13.91, 95% CI 7.23, 26.77) and with a median net loss of $985,952 (IQR $389,871-$1,700,041) per hospital annually for observation encounters. CONCLUSIONS Government-paid observation encounters for CMC are associated with significant financial loss at children's hospitals. This reimbursement model may pose a threat to children's hospitals' ability to care for CMC.
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Affiliation(s)
- Stephanie Arar
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Katherine Johnson
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Harita Katragadda
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Kelli Martinez
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Anum Dadwani
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Clifford N Chen
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Aishwarya Devarakonda
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Megan Gribbons
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Lasya Challa
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Ankita T Gupta
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Amee Patel
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Courtney Solomon
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Chloë E Nunneley
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Benjamin C Lee
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Andrew G Yu
- Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
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Rappaport DI, Wilding KM, Adkins L, Bourque M, Miller JM. How Will a Shift to Value-Based Financial Models Affect Care for Hospitalized Children? Hosp Pediatr 2024; 14:e177-e180. [PMID: 38351892 DOI: 10.1542/hpeds.2023-007400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- David I Rappaport
- Division of General Academic Pediatrics
- Utilization Management, Nemours Children's Hospital, Wilmington, Delaware
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karen Marie Wilding
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
| | - Lisa Adkins
- Utilization Management, Nemours Children's Hospital, Wilmington, Delaware
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
| | - Maryanne Bourque
- Utilization Management, Nemours Children's Hospital, Wilmington, Delaware
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
| | - Jonathan M Miller
- Division of General Academic Pediatrics
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
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Sabbatini AK, Parrish C, Liao JM, Wright B, Basu A, Kreuter W, Joynt-Maddox KE. Hospital Performance Under Alternative Readmission Measures Incorporating Observation Stays. Med Care 2023; 61:779-786. [PMID: 37712715 PMCID: PMC10592134 DOI: 10.1097/mlr.0000000000001920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To determine the extent to which counting observation stays changes hospital performance on 30-day readmission measures. METHODS This was a retrospective study of inpatient admissions and observation stays among fee-for-service Medicare enrollees in 2017. We generated 3 specifications of 30-day risk-standardized readmissions measures: the hospital-wide readmission (HWR) measure utilized by the Centers for Medicare and Medicaid Services, which captures inpatient readmissions within 30 days of inpatient discharge; an expanded HWR measure, which captures any unplanned hospitalization (inpatient admission or observation stay) within 30 days of inpatient discharge; an all-hospitalization readmission (AHR) measure, which captures any unplanned hospitalization following any hospital discharge (observation stays are included in both the numerator and denominator of the measure). Estimated excess readmissions for hospitals were compared across the 3 measures. High performers were defined as those with a lower-than-expected number of readmissions whereas low performers had higher-than-expected or excess readmissions. Multivariable logistic regression identified hospital characteristics associated with worse performance under the measures that included observation stays. RESULTS Our sample had 2586 hospitals with 5,749,779 hospitalizations. Observation stays ranged from 0% to 41.7% of total hospitalizations. Mean (SD) readmission rates were 16.6% (5.4) for the HWR, 18.5% (5.7) for the expanded HWR, and 17.9% (5.7) in the all-hospitalization readmission measure. Approximately 1 in 7 hospitals (14.9%) would switch from being classified as a high performer to a low performer or vice-versa if observation stays were fully included in the calculation of readmission rates. Safety-net hospitals and those with a higher propensity to use observation would perform significantly worse. CONCLUSIONS Fully incorporating observation stays in readmission measures would substantially change performance in value-based programs for safety-net hospitals and hospitals with high rates of observation stays.
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Affiliation(s)
- Amber K. Sabbatini
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, School of Public Health
| | - Canada Parrish
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, School of Public Health
| | - Joshua M. Liao
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- Value System Science Lab, Department of Medicine, University of Washington, Seattle, WA
| | - Brad Wright
- Department of Health Services, Policy and Management University of South Carolina School of Public Health, Columbia, SC
| | - Anirban Basu
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, WA
| | - William Kreuter
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, WA
| | - Karen E. Joynt-Maddox
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri
- Center for Health Economics and Policy, Institute for Public Health, Washington University in St Louis, St Louis, Missouri
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6
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Leyenaar JK, Freyleue SD, Arakelyan M, Goodman DC, O’Malley AJ. Pediatric Hospitalizations at Rural and Urban Teaching and Nonteaching Hospitals in the US, 2009-2019. JAMA Netw Open 2023; 6:e2331807. [PMID: 37656457 PMCID: PMC10474556 DOI: 10.1001/jamanetworkopen.2023.31807] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/07/2023] [Indexed: 09/02/2023] Open
Abstract
Importance National analyses suggest that approximately 1 in 5 US hospitals closed their pediatric units between 2008 and 2018. The extent to which pediatric hospitalizations at general hospitals in rural and urban communities decreased during this period is not well understood. Objective To describe changes in the number and proportion of pediatric hospitalizations and costs at urban teaching, urban nonteaching, and rural hospitals vs freestanding children's hospitals from 2009 to 2019; to estimate the number and proportion of hospitals providing inpatient pediatric care; and to characterize changes in clinical complexity. Design, Setting, and Participants This study is a retrospective cross-sectional analysis of the 2009, 2012, 2016, and 2019 Kids' Inpatient Database, a nationally representative data set of US pediatric hospitalizations among children younger than 18 years. Data were analyzed from February to June 2023. Exposures Pediatric hospitalizations were grouped as birth or nonbirth hospitalizations. Hospitals were categorized as freestanding children's hospitals or as rural, urban nonteaching, or urban teaching general hospitals. Main Outcomes and Measures The primary outcomes were annual number and proportion of birth and nonbirth hospitalizations and health care costs, changes in the proportion of hospitalizations with complex diagnoses, and estimated number and proportion of hospitals providing pediatric care and associated hospital volumes. Regression analyses were used to compare health care utilization in 2019 vs that in 2009. Results The data included 23.2 million (95% CI, 22.7-23.6 million) weighted hospitalizations. From 2009 to 2019, estimated national annual pediatric hospitalizations decreased from 6 425 858 to 5 297 882, as birth hospitalizations decreased by 10.6% (95% CI, 6.1%-15.1%) and nonbirth hospitalizations decreased by 28.9% (95% CI, 21.3%-36.5%). Concurrently, hospitalizations with complex chronic disease diagnoses increased by 45.5% (95% CI, 34.6%-56.4%), and hospitalizations with mental health diagnoses increased by 78.0% (95% CI, 61.6%-94.4%). During this period, the most substantial decreases were in nonbirth hospitalizations at rural hospitals (4-fold decrease from 229 263 to 62 729) and urban nonteaching hospitals (6-fold decrease from 581 320 to 92 118). In 2019, birth hospitalizations occurred at 2666 hospitals. Nonbirth pediatric hospitalizations occurred at 3507 hospitals, including 1256 rural hospitals and 843 urban nonteaching hospitals where the median nonbirth hospitalization volumes were fewer than 25 per year. Conclusions and Relevance Between 2009 and 2019, the largest decreases in pediatric hospitalizations occurred at rural and urban nonteaching hospitals. Clinical and policy initiatives to support hospitals with low pediatric volumes may be needed to maintain hospital access and pediatric readiness, particularly in rural communities.
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Affiliation(s)
- JoAnna K. Leyenaar
- Department of Pediatrics, Dartmouth Health Children’s, Lebanon, New Hampshire
| | - Seneca D. Freyleue
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Mary Arakelyan
- Department of Pediatrics, Dartmouth Health Children’s, Lebanon, New Hampshire
| | - David C. Goodman
- Department of Pediatrics, Dartmouth Health Children’s, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Johnson RF, Zhang J, Chorney SR, Kou YF, Lenes-Voit F, Ulualp S, Liu C, Mitchell RB. Estimations of Inpatient and Ambulatory Pediatric Tonsillectomy in the United States: A Cross-sectional Analysis. Otolaryngol Head Neck Surg 2023. [PMID: 36939461 DOI: 10.1002/ohn.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the incidence of inpatient and ambulatory pediatric tonsillectomies in the United States in 2019. STUDY DESIGN Cross-sectional analysis. SETTING Healthcare Cost and Utilization Project databases. METHODS We determined national incidences of hospital-based ambulatory procedures, inpatient admissions, and readmissions among pediatric tonsillectomy patients, ages 0 to 20 years, using the Kids Inpatient Database, Nationwide Ambulatory Surgery Sample, and Nationwide Readmission Database. We described the demographics, commonly associated conditions, complications, and predictors of readmission. RESULTS An estimated 559,900 ambulatory and 7100 inpatient tonsillectomies were performed in 2019. Among inpatients, the majority were male (59%) and the largest ethnic group was white (37%). Adenotonsillar hypertrophy (ATH), 79%, and obstructive sleep apnea (OSA), 74%, were the most frequent diagnosis and Medicaid (61%) was the most frequent primary payer. The majority of ambulatory tonsillectomy patients were female (52%) and white (65%); ATH, OSA, and Medicaid accounted for 62%, 29%, and 45% of cases, respectively, (all p < .001 when compared to inpatient cases). Common inpatient complications were bleeding (2%), pain/nausea/vomiting (5.6%), and postprocedural respiratory failure (1.7%). On the other hand, ambulatory complications occurred in less than 1% of patients. The readmission rate was 5.2%, with pain/nausea/vomiting and bleeding accounting for 35% and 23% of overall readmissions. All Patient Refined Diagnosis Related Groups severity of illness subclass predicted readmission (odds ratio = 2.18, 95% confidence interval = 1.73-2.73, p < .001). CONCLUSION A total of 567,000 pediatric ambulatory and inpatient tonsillectomies were performed in 2019; the majority were performed in ambulatory settings. The index admission severity of illness was associated with readmission risk.
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Affiliation(s)
- Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA.,Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Health, Dallas, Texas, USA
| | - Jinghan Zhang
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Stephen R Chorney
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA.,Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Health, Dallas, Texas, USA
| | - Yann-Fuu Kou
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA.,Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Health, Dallas, Texas, USA
| | - Felicity Lenes-Voit
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA.,Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Health, Dallas, Texas, USA
| | - Seckin Ulualp
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA.,Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Health, Dallas, Texas, USA
| | - Christopher Liu
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA.,Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Health, Dallas, Texas, USA
| | - Ron B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA.,Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Health, Dallas, Texas, USA
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8
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Bouchard ME, Kan K, Tian Y, Casale M, Smith T, De Boer C, Linton S, Abdullah F, Ghomrawi HMK. Association Between Neighborhood-Level Social Determinants of Health and Access to Pediatric Appendicitis Care. JAMA Netw Open 2022; 5:e2148865. [PMID: 35171257 PMCID: PMC8851303 DOI: 10.1001/jamanetworkopen.2021.48865] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Presenting with complicated appendicitis, which is associated with higher rates of complications and readmissions compared with simple appendicitis, may indicate delayed access to care. Although both patient-level and neighborhood-level social determinants of health are associated with access to care, little is known about the association between neighborhood factors and access to acute pediatric surgical care. OBJECTIVE To examine the association between neighborhood factors and the odds of presenting with complicated appendicitis and unplanned postdischarge health care use. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of patients aged 18 years or younger diagnosed with appendicitis was conducted. Discharge data from October 1, 2015, to September 30, 2018, were obtained from the Pediatric Health Information System Database and linked to the Child Opportunity Index (COI) 2.0 Database. Data analysis was conducted from January 1 through July 1, 2021. EXPOSURES The COI, a composite score of zip code neighborhood opportunity level information, divided into quintiles ranging from very low to very high opportunity. MAIN OUTCOMES AND MEASURES Based on COI level, the main outcome was the odds of presenting with complicated appendicitis, which was defined using the Agency for Healthcare Research and Quality-specified International Statistical Classification of Diseases, 10th Edition, Clinical Modification codes. The secondary outcome was the odds of unplanned postdischarge health care use (emergency department visits and/or readmissions) for patients with simple and with complicated appendicitis. RESULTS A total of 67 489 patients (mean [SD] age, 10.5 [3.9] years) had appendicitis, with 31 223 cases (46.3%) being complicated. A total of 1699 patients (2.5%) were Asian, 24 234 (35.9%) were Hispanic, 4447 (6.6%) were non-Hispanic Black, and 29 234 (43.3%) were non-Hispanic White; 40 549 patients (60.1%) were male; and 32 343 (47.9%) were publicly insured. Patients living in very low-COI neighborhoods had 28% higher odds of presenting with complicated appendicitis (odds ratio, 1.28; 95% CI, 1.20-1.35) compared with those in very high-COI neighborhoods. There was no significant association between COI level and unplanned postdischarge health care use (very high COI, 20.8%; very low COI, 19.1%). CONCLUSIONS AND RELEVANCE In this cohort study, children from lower-COI neighborhoods had increased odds of presenting with complicated appendicitis compared with those from higher-COI neighborhoods, even after controlling for patient-level social determinants of health factors. These findings may inform policies and programs that seek to improve access to pediatric surgical care.
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Affiliation(s)
- Megan E. Bouchard
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Kristin Kan
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Yao Tian
- Departments of Surgery and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mia Casale
- Population Health Analytics, Division of Data Analytics and Reporting, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Tracie Smith
- Population Health Analytics, Division of Data Analytics and Reporting, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Christopher De Boer
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Samuel Linton
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Departments of Surgery and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hassan M. K. Ghomrawi
- Departments of Surgery and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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9
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Synhorst DC, Bettenhausen JL. Problematic Trends in Observation Status for Children's Hospitals. J Hosp Med 2021; 16:701. [PMID: 34752213 DOI: 10.12788/jhm.3694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022]
Affiliation(s)
- David C Synhorst
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Jessica L Bettenhausen
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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10
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Tian Y, Ingram MCE, Hall M, Raval MV. ICD-10 Transition Influences Trends in Perforated Appendix Admission Rate. J Surg Res 2021; 266:345-351. [PMID: 34077864 DOI: 10.1016/j.jss.2021.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/27/2021] [Accepted: 04/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study sought to evaluate the influence of International Classification of Diseases, Tenth Revision (ICD-10) transition on Perforated Appendix Admission Rate (PAAR), which is a commonly used indicator representing access to care developed by Agency for Healthcare Research and Quality (AHRQ). MATERIALS AND METHODS In this interrupted time series study of Pediatric Health Information System database from 2013 to 2018, we employed three study phases (pre-implementation, washout, and initial implementation) to evaluate the influence of ICD-10 transition on trends in PAAR. ICD-10 diagnosis codes suggested by AHRQ's specifications were used to identify perforated and simple appendicitis, and PAAR was estimated accordingly. Generalized linear mixed models were used to examine the association of ICD-10 initial implementation and being documented as perforated appendicitis on encounter level. RESULTS We identified a total of 94,810 encounters diagnosed with appendicitis, and almost all patients' characteristics were similar over the three study phases, except for PAAR. The pre-implementation PAAR in October 2013 was 33.1%, and the immediate influence of ICD-10 transition on PAAR was 3.2% (P = 0.002), with a 0.38% per quarter increase over time (P = 0.02). After adjusting for age, gender, race/ethnicity, payer, and year, the likelihood of being documented as having perforated appendicitis in 2016 was 1.5 times higher than the estimated likelihood before the implementation (adjusted Odds Ratio: 1.51; 95% Confidence Interval: 1.40-1.63; P < 0.001). CONCLUSIONS The 2015-2018 ICD-10 transition may be erroneously associated with an increasing trend of PAAR. Care should be taken when interpreting the metric during this period.
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Affiliation(s)
- Yao Tian
- Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| | - Martha-Conley E Ingram
- Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois 60611
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Mehul V Raval
- Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois 60611.
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