First name
Stephen
Middle name
W
Last name
Patrick

Title

Trends in Length of Stay and Readmissions in Children's Hospitals.

Year of Publication

2021

Date Published

2021 May 04

ISSN Number

2154-1671

Abstract

<p><strong>BACKGROUND AND OBJECTIVES: </strong>Patient complexity at US children's hospitals is increasing. Hospitals experience concurrent pressure to reduce length of stay (LOS) and readmissions, yet little is known about how these common measures of resource use and quality have changed over time. Our aim was to examine temporal trends in medical complexity, hospital LOS, and readmissions across a sample of US children's hospitals.</p>

<p><strong>METHODS: </strong>Retrospective cohort study of hospitalized patients from 42 children's hospitals in the Pediatric Health Information System from 2013 to 2017. After excluding deaths, healthy newborns, obstetric care, and low volume service lines, we analyzed trends in medical complexity, LOS, and 14-day all-cause readmissions using generalized linear mixed effects models, adjusting for changes in patient factors and case-mix.</p>

<p><strong>RESULTS: </strong>Between 2013 and 2017, a total of 3 355 815 discharges were included. Over time, the mean case-mix index and the proportion of hospitalized patients with complex chronic conditions or receiving intensive care increased ( &lt; .001 for all). In adjusted analyses, mean LOS declined 3% (61.1 hours versus 59.3 hours from 2013 to 2017, &lt; .001), whereas 14-day readmissions were unchanged (7.0% vs 6.9%; = .03). Reductions in adjusted LOS were noted in both medical and surgical service lines (3.6% and 2.0% decline, respectively; &lt; .001).</p>

<p><strong>CONCLUSIONS: </strong>Across US children's hospitals, adjusted LOS declined whereas readmissions remained stable, suggesting that children's hospitals are providing more efficient care for an increasingly complex patient population.</p>

DOI

10.1542/hpeds.2020-004044

Alternate Title

Hosp Pediatr

PMID

33947746

Title

It Is Time to ACT NOW to Improve Quality for Opioid-Exposed Infants.

Year of Publication

2021

Date Published

2021 Jan

ISSN Number

1098-4275

DOI

10.1542/peds.2020-028340

Alternate Title

Pediatrics

PMID

33386340

Title

Cost of clinician-driven tests and treatments in very low birth weight and/or very preterm infants.

Year of Publication

2020

Date Published

2020 Dec 02

ISSN Number

1476-5543

Abstract

<p><strong>OBJECTIVE: </strong>To rank clinician-driven tests and treatments (CTTs) by their total cost during the birth hospitalization for preterm infants.</p>

<p><strong>STUDY DESIGN: </strong>Retrospective cohort of very low birth weight (&lt;1500 g) and/or very preterm (&lt;32 weeks) subjects admitted to US children's hospital Neonatal Intensive Care Units (2012-2018). CTTs were defined as pharmaceutical, laboratory and imaging services and ranked by total cost.</p>

<p><strong>RESULTS: </strong>24,099 infants from 51 hospitals were included. Parenteral nutrition ($85M, 32% of pharmacy costs), blood gas analysis ($34M, 29% of laboratory costs), and chest radiographs ($18M, 31% of imaging costs) were the costliest CTTs overall. More than half of CTT-related costs occurred during 10% of hospital days.</p>

<p><strong>CONCLUSIONS: </strong>The majority of CTT-related costs were from commonly used tests and treatments. Targeted efforts to improve value in neonatal care may benefit most from focusing on reducing unnecessary utilization of common tests and treatments, rather than infrequently used ones.</p>

DOI

10.1038/s41372-020-00879-6

Alternate Title

J Perinatol

PMID

33268831

Title

Neonatal Opioid Withdrawal Syndrome.

Year of Publication

2020

Date Published

2020 Oct 26

ISSN Number

1098-4275

Abstract

<p>The opioid crisis has grown to affect pregnant women and infants across the United States, as evidenced by rising rates of opioid use disorder among pregnant women and neonatal opioid withdrawal syndrome among infants. Across the country, pregnant women lack access to evidence-based therapies, including medications for opioid use disorder, and infants with opioid exposure frequently receive variable care. In addition, public systems, such as child welfare and early intervention, are increasingly stretched by increasing numbers of children affected by the crisis. Systematic, enduring, coordinated, and holistic approaches are needed to improve care for the mother-infant dyad. In this statement, we provide an overview of the effect of the opioid crisis on the mother-infant dyad and provide recommendations for management of the infant with opioid exposure, including clinical presentation, assessment, treatment, and discharge.</p>

DOI

10.1542/peds.2020-029074

Alternate Title

Pediatrics

PMID

33106341

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