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Study shows how to reduce length of stay for pediatric patients

Quality Improvement Monitor, September 30, 2004

Children's hospitals can discharge pediatric patients sooner, less expensively, and with less chance of a repeat visit simply by checking their performance against similar hospitals to identify areas in which they can improve, according to new research in the October issue Pediatrics (Vol. 11, No. 4).

The study is based on data from children who had asthma attacks that required hospitalization. But the authors say their approach could be used to evaluate and improve care of any kind at any children's hospital. If more hospitals paid this kind of attention to detailed data and acted on the results, they could provide cheaper, more efficient, higher-quality care to more children, the researchers say.

Researchers at the University of Michigan's C.S. Mott Children's Hospital reduced the length and cost growth of asthmatic children's hospital stays, and their readmission rates, by using child-specific national data to check Mott's performance and look for opportunities to improve the delivery of asthma care in the hospital.

The team used data from the Case Mix Comparative Database available from theNational Association of Children's Hospitals and Related Institutions (NACHRI). The database contains information on patients treated at NACHRI member hospitals and adjusts the patients' medical codes by severity of illness and co-existing conditions. This better reflects the nature of children's health problems and the mix of patients, or "case mix" at children's hospitals.

The adjusted medical codes and database allow a children's hospital to make an "apples to apples" comparison against the average performance of all other hospitals. Such comparisons can be made for specific conditions, such as asthma or infectious diseases, and broken down by the severity of the condition. Where there is room for improvement, the data point medical staff toward opportunities for change.

Aileen Sedman, MD, and colleagues examined Mott's performance in the NACHRI database to see how its average hospital stay compared with the national average. Mott's average length of stay in 1999 for level 1 asthma patients was 2.16 days, compared with a national average of 2.14 days.

"That's not a huge difference, but since we were far under the national average for more severe patients, we wanted to improve," says Sedman.

After a quality improvement process was in place for three years, the team repeated the comparison. On length of stay, both the national average and the Mott average dropped, although Mott was able to discharge children in 1.75 days, compared with a national figure of 2 days. Costs increased on both sides, but Mott contained cost growth to 12% while the national average growth was 18%.

Even more significantly, the education effort seemed to work: the percentage of level 1 asthma patients who were readmitted within 30 days for another asthma attack dropped from 3% to less than 1%. During the same period, the national readmission rate hovered around 2%. Mott also had no deaths among its level 1 asthma patients; there were several nationwide. The study is titled, Clinical Redesign Using All Patient Refined Diagnosis Related Groups.

-- Wendy Johnson
wjohnson@hcpro.com

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