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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Variation in resource use and readmission for diabetic ketoacidosis in children's hospitals
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Variation in resource use and readmission for diabetic ketoacidosis in children's hospitals

机译：儿童医院糖尿病性酮症酸中毒的资源使用和再入院情况有所不同

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OBJECTIVE: We sought to characterize variation in hospital resource utilization and readmission for diabetic ketoacidosis (DKA) across US children's hospitals. METHODS: The study sample included a retrospective cohort of children aged 2 to 18 years with a diagnosis of DKA at 38 children's hospitals between 2004 and 2009. The main outcomes were resource utilization as determined by total standardized cost per hospitalization, overall and non-ICU length of stay (LOS), and readmission for DKA within 30 and 365 days. RESULTS: There were 24 890 DKA admissions, and 20.3% of these were readmissions within 1 year. The mean hospital-level total standardized cost was $7142 (range $4125-$11 916). The mean hospital-level LOS was 2.5 days (1.5-3.7), and the non-ICU portion was 1.9 days (0.7-2.7). The mean hospital-level readmission within 365 days was 18.7% (6.5%-41.1%) and within 30 days was 2.5% (0.0%-7.1%). Hospital bed days overall, and in particular the non-ICU portion, accounted for the majority of the total standardized cost per hospitalization (overall 57%; non-ICU 36%) and explained most of the variation in resource use. Even after adjusting for difference in patient characteristics across hospitals, widespread differences existed across hospitals in total standardized cost, LOS, and readmission rates (P , .001). CONCLUSIONS: Readmission for DKA within a year of hospitalization is common. US children's hospitals vary widely in resource use, hospital LOS, and readmission rates for patients with DKA. Our study highlights the need for additional research to understand these differences and to identify the most cost-effective strategies for managing diabetes across the continuum of care. Pediatrics 2013;132:229-236
机译：目的：我们试图描述美国儿童医院糖尿病酮症酸中毒（DKA）在医院资源利用和再入院方面的差异。方法：研究样本包括2004年至2009年间38所儿童医院中诊断为DKA的2至18岁儿童的回顾性队列。主要结果是资源利用率，由每次住院的总标准化成本，总体和非ICU确定住院天数（LOS），以及30到365天内DKA的重新入院。结果：共有24 890例DKA入院，其中20.3％为1年内的再入院。平均医院一级的总标准化成本为$ 7142（范围为$ 4125- $ 11,916）。医院平均LOS为2.5天（1.5-3.7），非ICU部分为1.9天（0.7-2.7）。 365天内的平均医院再入院率为18.7％（6.5％-41.1％），而30天内的平均住院率为2.5％（0.0％-7.1％）。总体而言，医院病床天数，尤其是非ICU部分，占每次住院总标准化费用的大部分（总57％;非ICU 36％），并解释了资源使用方面的大部分差异。即使在调整了医院之间患者特征的差异之后，各医院在总标准化成本，LOS和再入院率方面仍存在广泛差异（P≤.001）。结论：住院期间一年内再次入院DKA很常见。美国儿童医院的资源使用，医院服务水平和DKA患者的再入院率差异很大。我们的研究强调需要进行更多的研究，以了解这些差异并确定在整个护理过程中管理糖尿病的最具成本效益的策略。儿科2013; 132：229-236

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