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. 2021 Mar;11(3):231-238.
doi: 10.1542/hpeds.2020-000778.

Comparing Patterns of Care for Febrile Infants at Community and University-Affiliated Hospitals

Rachel Cane  1 , Ellen Kerns  2   3 , Lauren Maskin  2   3 , Beth Natt  4 , Lisa Sieczkowski  2   3 , Eric Biondi  5 , Russell J McCulloh  2   3
Affiliations

Comparing Patterns of Care for Febrile Infants at Community and University-Affiliated Hospitals

Rachel Cane et al. Hosp Pediatr. 2021 Mar.

Abstract

Objectives: Most children in the United States receive treatment in community hospitals, but descriptions of clinical practice patterns in pediatric care in this setting are lacking. Our objectives were to compare clinical practice patterns primarily between community and university-affiliated hospitals and secondarily by number of pediatric beds before and during participation in a national practice standardization project.

Methods: We performed a retrospective secondary analysis on data from 126 hospitals that participated in the American Academy of Pediatrics' Value in Inpatient Pediatrics Reducing Excessive Variability in the Infant Sepsis Evaluation project, a national quality improvement project conducted to improve care for well-appearing febrile infants aged 7 to 60 days. Four use measures were compared by hospital type and by number of non-ICU pediatric beds.

Results: There were no differences between community and university-affiliated hospitals in the odds of hospital admission, average length of stay, or odds of cerebrospinal fluid culture. The odds of chest radiograph at community hospitals were higher only during the baseline period. There were no differences by number of pediatric beds in odds of admission or average length of stay. For hospitals with ≤30 pediatric beds, the odds of chest radiograph were higher and the odds of cerebrospinal fluid culture were lower compared with hospitals >50 beds during both study periods.

Conclusions: In many key aspects, care for febrile infants does not differ between community and university-affiliated hospitals. Clinical practice may differ more by number of pediatric beds.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Biondi provides consultation for McKesson Incorporated; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Sites participating in the REVISE project. Shown is the geographical distribution of participating sites by hospital type (community versus university affiliated) and number of pediatric beds.
FIGURE 2
FIGURE 2
Differences in use measures by hospital type (community versus university affiliated). A, Crude distribution revealing median (horizontal line) and interquartile range (edges of the box). B, Adjusted odds of use and difference in length of stay (LOS). The vertical dashed line is the value for the reference group (university-affiliated hospitals). When CI bars cross the vertical dashed line, the OR does not attain statistical significance. CXR, chest radiograph. a OR: 1.8 (95% CI: 1.2–2.7).
FIGURE 3
FIGURE 3
Differences in use measures by number of pediatric beds. A, Crude distribution revealing median (horizontal line) and interquartile range (edges of the box). B, Adjusted odds of use and difference in length of stay (LOS). The vertical dashed line is the value for the reference group (>50 beds). When CI bars cross the vertical dashed line, the OR does not attain statistical significance. CXR, chest radiograph. a OR: 8.91 (95% CI: 3.38–23.5). b OR: 2.36 (95% CI: 1.53–3.63). c OR: 3.84 (95% CI: 1.53–9.64). d OR: 1.69 (95% CI: 1.12–2.54). e OR: 0.22 (95% CI: 0.11–0.45). f OR: 0.56 (95% CI: 0.41–0.76). g OR: 0.33 (95% CI: 0.14–0.76). h OR: 0.56 (95% CI: 0.39–0.80).
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References

    1. Leyenaar JK, Ralston SL, Shieh M-S, Pekow PS, Mangione-Smith R, Lindenauer PK. Epidemiology of pediatric hospitalizations at general hospitals and freestanding children’s hospitals in the United States. J Hosp Med. 2016;11(11):743–749 - PMC - PubMed
    1. McDaniel CE, Jennings R, Schroeder AR, Paciorkowski N, Hofmann M, Leyenaar J. Aligning inpatient pediatric research with settings of care: a call to action. Pediatrics. 2019;143(5):e20182648. - PubMed
    1. Good M, McElroy SJ, Berger JN, Wynn JL. Name and characteristics of National Institutes of Health R01-Funded Pediatric Physician-Scientists: hope and challenges for the vanishing pediatric physician-scientists. JAMA Pediatr. 2018;172(3):297–299 - PMC - PubMed
    1. Keren R, Luan X, Localio R, et al. ; Pediatric Research in Inpatient Settings (PRIS) Network. Prioritization of comparative effectiveness research topics in hospital pediatrics. Arch Pediatr Adolesc Med. 2012;166(12):1155–1164 - PubMed
    1. França UL, McManus ML. Availability of definitive hospital care for children. JAMA Pediatr. 2017;171(9):e171096. - PMC - PubMed

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