title: Pediatric hospital adherence to the standard of care for acute gastroenteritis.
abstract: BACKGROUND
  Adherence to published care guidelines for the management of acute gastroenteritis (AGE) is unknown.
  
  
  OBJECTIVE
  To evaluate the association of AGE guideline adherence with outcomes and resource use at pediatric hospitals.
  
  
  METHODS
  We studied children aged 6 months to 6 years with an International Classification of Diseases, Ninth Edition (ICD-9) discharge code indicative of AGE and without comorbid conditions in the emergency department, observation setting, or hospital. Laboratory studies, antiemetic use, and antibiotic use were evaluated, and the length of stay, mean adjusted total charges, and readmission proportion were documented. Multiple analysis of variance determined if the variance of adjusted charges, length of stay, and diagnostic studies were hospital-related. A regression analysis determined the association between guideline adherence and outcomes.
  
  
  RESULTS
  There were a total of 188873 patients; 174594 (92.4%) were not admitted, and 14279 (7.6%) were admitted. There was substantial variation in resource use among hospitals. The mean adjusted total charge for all patients was $863 (SD: 1336). The mean adjusted total charge for nonadmitted patients was $591 (SD: 636). Individual hospitals contributed to the variance of mean length of stay, total adjusted charges, and use of diagnostic studies after controlling for covariates (P < .001). Guideline adherence was associated with a mean decrease in the average adjusted cost ($591) for nonadmitted patients of $296 (95% confidence interval: -399 to -193).
  
  
  CONCLUSIONS
  Guideline-adherent hospitals demonstrated 50% lower charges for emergency department or observation patients with uncomplicated AGE without adversely affecting outcomes. Use of resources not routinely recommended by published AGE guidelines remains common in pediatric hospitals.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA. joel.tieder@seattlechildrens.org
authors.forename: Joel S
authors.initials: JS
authors.lastname: Tieder
authors.forename: Andrea
authors.initials: A
authors.lastname: Robertson
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Garrison
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D000932:Antiemetics / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005759:Gastroenteritis / Q000191:economics / Q000628:therapy*; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D000932:Antiemetics