Variations in management of common inpatient pediatric illnesses: hospitalists and community pediatricians.
OBJECTIVE
The goal was to test the hypothesis that pediatric hospitalists use evidence-based therapies and tests more consistently in the care of inpatients and use therapies and tests of unproven benefit less often, compared with community pediatricians.


METHODS
A national survey was administered to hospitalists and a random sample of community pediatricians. Hospitalists and community pediatricians reported their frequency of use of diagnostic tests and therapies, on 5-point Likert scales (ranging from never to almost always), for common inpatient pediatric illnesses. Responses were compared in univariate and multivariable logistic regression analyses controlling for gender, race, years out of residency, days spent attending per year, hospital practice type, and completion of fellowship/postgraduate training.


RESULTS
Two hundred thirteen pediatric hospitalists and 352 community pediatricians responded. In multivariable regression analyses, hospitalists were significantly more likely to report often or almost always using the following evidence-based therapies for asthma: albuterol and ipratropium in the first 24 hours of hospitalization. After the first urinary tract infection, hospitalists were more likely to report obtaining the recommended renal ultrasound and voiding cystourethrogram. Hospitalists were significantly more likely than community pediatricians to report rarely or never using the following therapies of unproven benefit: levalbuterol, inhaled steroid therapy, and oral steroid therapy for bronchiolitis; stool culture and rotavirus testing for gastroenteritis; and ipratropium after 24 hours of hospitalization for asthma.


CONCLUSIONS
Overall, in comparison with community pediatricians, hospitalists reported greater adherence to evidence-based therapies and tests in the care of hospitalized patients and less use of therapies and tests of unproven benefit.
Conway
Patrick H
PH
Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA. pconway@cceb.upenn.edu
Edwards
Sarah
S
Stucky
Erin R
ER
Chiang
Vincent W
VW
Ottolini
Mary C
MC
Landrigan
Christopher P
CP
D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000420:Albuterol / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy; D001988:Bronchiolitis / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D004501:Education, Medical / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005243:Feces / Q000382:microbiology / Q000821:virology; D005759:Gastroenteritis / Q000821:virology; D006801:Humans; D007223:Infant; D007297:Inpatients; D007325:Institutional Practice / Q000706:statistics & numerical data*; D007396:Internship and Residency / Q000706:statistics & numerical data; D009241:Ipratropium / Q000627:therapeutic use; D010372:Pediatrics / Q000193:education / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011331:Private Practice / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D011859:Radiography; D012401:Rotavirus / Q000302:isolation & purification; D013997:Time Factors; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging / Q000188:drug therapy
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D009241:Ipratropium; D000420:Albuterol