News: Pediatric hospitalization index omits key observational status data, study shows

Preventable hospitalization rates in pediatric populations have been decreasing in the past 15 years; however, some of the apparent decrease is due to omitting observation stay data, according to a new study.

The study, entitled “Trends in Preventable Hospitalization Rates for Children With or Without Observation Stay Data,” examined 64,846 hospital stays occurring between 2010 and 2019 in the states of Georgia, Iowa, Maryland, Nebraska, and Vermont. The researchers also examined pediatric ambulatory data in Wisconsin from 2012 to 2019.

According to the authors, preventable hospitalization rates are “widely used quality indicators that have been used to evaluate the impact of policies and programs aiming to improve access to high-quality primary and ambulatory care for children.”

However, observation stay data traditionally has not been included in preventable hospitalization rate measures. According to the authors, the result is that “ this growing portion of pediatric hospital stays are not considered in current policy evaluations or payment reforms.”

Therefore, the researchers re-integrated such observation stay data into their calculations for preventable hospitalization rates among pediatric populations. Here are the three major conclusions from the study:

• “When using inpatient-only data, the overall aggregate-level composite hospitalization rate per 100 000 children was 141.7 in 2010 and decreased to 71.0 in 2019, and the annual percentage change was −6.8%.”
• “When using combined data (i.e., observation + inpatient), the composite hospitalization rate was 203.0 in 2010 and 130.7 in 2019, respectively, with an annual percentage change of −4.5%.”
• The preventable hospitalization data trends possessed “substantial variation” at the county level.

Therefore, the authors recommended utilizing both observation stay data and inpatient data when calculating preventable hospitalization rates for pediatric populations to get a more accurate clinical picture. They also indicated that is “essential” to “standardize the reporting and inclusion of observation stay data to support disease surveillance, policy evaluation, and decision-making.”

Editor’s note: To read the JAMA Network Open article, click here.