FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 318:1033-1037 April 21, 1988 Number 16 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

To assess the extent of inappropriate hospital use in pediatric inpatients, I modified the Appropriateness Evaluation Protocol (AEP)--developed to assess inappropriate hospital use in adults--to apply to children and used it to evaluate pediatric inpatients retrospectively for every 10th day, from July 1982 to July 1983, at the University of Wisconsin Hospital. Of 1098 patient-days evaluated, 21.4 percent were judged to represent inappropriate hospital use on the basis of the protocol's criteria. The rate of inappropriate use varied according to admitting specialty, ranging from 7 of 70 days (10 percent) for pulmonary medicine to 43 of 61 days (70 percent) for neurology (P less than 0.005). There was a tendency toward lower rates of inappropriate use in uninsured patients (6 of 44 days [14 percent] vs. 226 of 1038 days [22 percent] in patients with Medicaid or private insurance, P = 0.13), and rates were lower in younger children (74 of 432 days [17 percent] in children less than or equal to 5 years of age vs. 162 of 656 days [25 percent] in children greater than 5 years of age, P less than 0.005). There was no variation according to sex, day of the week, or month. Contrary to expectations, inappropriate use decreased with increased lengths of stay (for stays of 1 day, 8 of 13 days were inappropriate [61 percent]; for stays of 2 to 6 days, 118 of 410 days were inappropriate [29 percent]; for 7 to 13 days, 58 of 291 [20 percent]; and for greater than or equal to 14 days, 51 of 362 [14 percent], P less than 0.001). I conclude that there is a substantial rate of inappropriate hospital use in pediatrics and that such use is more likely during short admissions than during long ones. Cost-containment efforts directed at limiting the length of hospitalization may therefore not reduce inappropriate hospital use in this population.

Source Information

Department of Pediatrics, University of Wisconsin Hospitals and Clinics, Madison.

This article has been cited by other articles:

• Mahant, S., Peterson, R., Campbell, M., MacGregor, D. L., Friedman, J. N. (2008). Reducing Inappropriate Hospital Use on a General Pediatric Inpatient Unit. Pediatrics 121: e1068-e1073 [Abstract] [Full Text]  
• De Marco, G., Mangani, S., Correra, A., Di Caro, S., Tarallo, L., De Franciscis, A., Jefferson, T., Guarino, A. (2005). Reduction of Inappropriate Hospital Admissions of Children With Influenza-Like Illness Through the Implementation of Specific Guidelines: A Case-Controlled Study. Pediatrics 116: e506-e511 [Abstract] [Full Text]  
• Bianco, A., Pileggi, C., Trani, F., Angelillo, I. F. (2003). Appropriateness of Admissions and Days of Stay in Pediatric Wards of Italy. Pediatrics 112: 124-128 [Abstract] [Full Text]  
• SANGHA, O., SCHNEEWEISS, S., WILDNER, M., COOK, E. F., BRENNAN, T. A., WITTE, J., LIANG, M. H. (2002). Metric properties of the appropriateness evaluation protocol and predictors of inappropriate hospital use in Germany: an approach using longitudinal patient data. Int J Qual Health Care 14: 483-492 [Abstract] [Full Text]  
• Rosenthal, G. E., Sirio, C. A., Shepardson, L. B., Harper, D. L., Rotondi, A. J., Cooper, G. S. (1998). Use of Intensive Care Units for Patients With Low Severity of Illness. Arch Intern Med 158: 1144-1151 [Abstract] [Full Text]  
• Werneke, U., Smith, H., Smith, I. J, Taylor, J., MacFaul, R. (1997). Validation of the paediatric appropriateness evaluation protocol in British practice. Arch. Dis. Child. 77: 294-298 [Abstract] [Full Text]  
• Merrick, N., Davidson, B., Fox, S. (1996). Treatment of Acute Gastroenteritis: Too Much and Too Little Care. CLIN PEDIATR 35: 429-435 [Abstract]  
• Halpin Schauffler, H., Rodriguez, T. (1993). Managed Care for Preventive Services: A Review of Policy Options. Med Care Res Rev 50: 153-198  
• Baigelman, W. (1991). Identifying Physicians and Patterns Generating Unnecessary In-Hospital Days: An Exploratory Stage of Developing an Institution-Specific Physician-Focused Utilization Effort. American Journal of Medical Quality 6: 95-98 [Abstract]  
• Wickizer, T. M. (1990). The Effect of Utilization Review on Hospital Use and Expenditures: A Review of the Literature and an Update on Recent Findings. Med Care Res Rev 47: 327-363