Estimating Risk Associated With Care in Alternative Settings

McConnochie, Kenneth M.; Callahan, Charles M.; Conners, Gregory P.; Roghmann, Klaus J.

doi:10.1001/archpedi.152.7.651

Cited by 8 publications

(4 citation statements)

References 17 publications

(32 reference statements)

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“…Work from McConnochie et al19–21 in the 1990s indicated that a significant number of pediatric hospitalizations could be cared for in an alternative setting, such as an observation unit. Individual institutions have been successful in using pediatric observation units to decrease LOS,2,4,9,22 reduce admission rates,5,10,23 and control costs 2,9.…”

mentioning

confidence: 99%

Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993–2003

Macy¹,

Stanley²,

Lozon³

et al. 2009

Pediatrics

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OBJECTIVE-Brief hospitalizations for children may constitute an opportunity to provide care in an alternative setting such as an observation unit. The goal of this study was to characterize recent national trends in brief inpatient stays for children in the United States.METHODS-Using the Nationwide Inpatient Sample from 1993-2003, we analyzed hospital discharges among children <18 years of age, excluding births, deaths, and transfers. Hospitalizations with lengths of stay of 0 and 1 night were designated as "high turnover." Serial cross-sectional analyses were conducted to compare the proportion of high-turnover stays across and within years according to patient and hospital-level characteristics. Diagnosis-related groups and hospital charges associated with these observation-length stays were examined. RESULTS-In 2003, there were an estimated 441 363 high-turnover hospitalizations compared with 388 701 in 1993. The proportion of high-turnover stays increased from 24.9% in 1993 to 29.9% in 1999 and has remained ≥30.0% since that time. Diagnosis-related groups for high-turnover stays reflect common pediatric medical and surgical conditions requiring hospitalization, including respiratory illness, gastrointestinal/metabolic disorders, seizure/headache, and appendectomy. Significant increases in the proportion of high-turnover stays during the study period were noted across patient and hospital-level characteristics, including age group, payer, hospital location, teaching status, bed size, and admission source. High-turnover stays contributed $1.3 billion (22%) to aggregate hospital charges in 2003, an increase from $494 million (12%) in 1993. CONCLUSIONS-Consistently since 1999, nearly one third of children hospitalized in the UnitedStates experience a high-turnover stay. These high-turnover cases constitute hospitalizations, that may be eligible for care in an alternative setting. Observation units provide 1 model for an efficient and cost-effective alternative to inpatient care, in which resources and provider interactions with patients and each other are geared toward shorter stays with more timely discharge processes. Observation units have widespread use in adult emergency medicine, demonstrating a strong track record with shorter stays and reduced ward admission rates for common conditions such as chest pain, asthma, and cellulitis. [12][13][14][15][16][17][18] Work from McConnochie et al [19][20][21] in the 1990s indicated that a significant number of pediatric hospitalizations could be cared for in an alternative setting, such as an observation unit. Individual institutions have been successful in using pediatric observation units to decrease LOS, 2,4,9,22 reduce admission rates, 5,10,23 and control costs. 2,9 However, little is known about the potential at the national level for children to receive care in an observation unit setting. KeywordsIn this study, we used the Nationwide Inpatient Sample (NIS) over a period of 1 decade to provide national estimates of the number of US children who experi...

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mentioning

confidence: 99%

Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993–2003

Macy¹,

Stanley²,

Lozon³

et al. 2009

Pediatrics

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“…Much of the literature comprises accounts of service development (Box 1993) or descriptive studies of parent or professional views Sartain 2001). Literature related to the safety of models of care is limited (McConnochie 1998;Montalto 1998) and concerns are rapidly increasing about the impact of changes in delivery and financing mechanisms on quality of care . Empirical data are needed about the e ects of specialist home-based nursing services for children with acute and chronic illnesses, to explore the strengths and weaknesses of di erent service models, as well as general e icacy.…”

Section: Why It Is Important To Do This Reviewmentioning

confidence: 99%

Specialist home-based nursing services for children with acute and chronic illnesses

Parab

Cooper

Woolfenden³

et al. 2013

Cochrane Database of Systematic Reviews

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Current research does not provide supporting evidence for a reduction in access to hospital services or a reduction in hospital readmission rate for children with acute and chronic illnesses using specialist home-based nursing services; however, the only summary finding across a few studies was that there is a significant decrease in length of hospitalisation. The preliminary results show no adverse impact on physical health outcomes and a number of papers reported improved satisfaction with home-based care. Further trials are required, measuring health, satisfaction, service utilisation and long-term costs.

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“…It is vital that emerging paediatric ambulatory and community services are continually monitored for adverse outcomes through clear and measurable clinical indicators. 15,16 Of note, a systematic review of randomised controlled trials is currently under way to assess the evidence for the impact of such services in terms of positive outcomes and harm. 17 Despite these limitations in outcome assessment, this paediatric ambulatory and community service has begun to show benefits in terms of greater access for families to community outreach through increased referral, parental satisfaction and saved hospital bed-days.…”

Section: Improving the Processes Of Carementioning

confidence: 99%

The first eighteen months of a paediatric ambulatory and community service

Woolfenden

Dalkeith²,

Anderson³

2005

Aust. Health Review

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Hospital admission is distressing and traumatic for children as they are separated from their families and home. Internationally, and in Australia, alternative models of health care are being developed to meet the needs of children and their families. We describe the first eighteen months of the establishment of a paediatric ambulatory and community service in a district health service in New South Wales. Key outcomes include: increased referral to the service from acute hospital and primary care services; parental satisfaction and saved hospital beddays. Lessons learnt in the setting up of this service include the need for proactive engagement of consumers and stakeholders; clear definition of roles and responsibilities; and measurable and reasonable performance indi- cators.

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Estimating Risk Associated With Care in Alternative Settings

Cited by 8 publications

References 17 publications

Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993–2003

Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993–2003

Specialist home-based nursing services for children with acute and chronic illnesses

The first eighteen months of a paediatric ambulatory and community service

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