title: Use of prolonged travel to improve pediatric risk-adjustment models.
abstract: OBJECTIVE
  To determine whether travel variables could explain previously reported differences in lengths of stay (LOS), readmission, or death at children's hospitals versus other hospital types.
  
  
  METHODS
  Hospital discharge data from Pennsylvania between 1996 and 1998.
  
  
  METHODS
  A population cohort of children aged 1-17 years with one of 19 common pediatric conditions was created (N=51,855). Regression models were constructed to determine difference for LOS, readmission, or death between children's hospitals and other types of hospitals after including five types of additional illness severity variables to a traditional risk-adjustment model.
  
  
  RESULTS
  With the traditional risk-adjustment model, children traveling longer to children's or rural hospitals had longer adjusted LOS and higher readmission rates. Inclusion of either a geocoded travel time variable or a nongeocoded travel distance variable provided the largest reduction in adjusted LOS, adjusted readmission rates, and adjusted mortality rates for children's hospitals and rural hospitals compared with other types of hospitals.
  
  
  CONCLUSIONS
  Adding a travel variable to traditional severity adjustment models may improve the assessment of an individual hospital's pediatric care by reducing systematic differences between different types of hospitals.
authors.affiliation: Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. lorch@email.chop.edu
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lorch
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Silber
authors.forename: Orit
authors.initials: O
authors.lastname: Even-Shoshan
authors.forename: Andrea
authors.initials: A
authors.lastname: Millman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008962:Models, Theoretical; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D010372:Pediatrics; D010414:Pennsylvania; D011785:Quality Assurance, Health Care; D020379:Risk Adjustment; D012720:Severity of Illness Index; D014195:Travel