title: Patient volume and quality of care for young children hospitalized with acute gastroenteritis.
abstract: OBJECTIVE
  To explore the relationship between the volume of children admitted to the hospital with acute gastroenteritis and adherence to recommended quality indicators.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Premier Perspective clinical and financial information systems database (Premier Inc, Charlotte, North Carolina).
  
  
  METHODS
  A total of 12,604 otherwise healthy children aged 3 months to 10 years hospitalized between January 1, 2007, and December 31, 2009, at 280 US hospitals with International Classification of Diseases, Ninth Revision diagnosis codes indicating acute gastroenteritis.
  
  
  METHODS
  Volume of hospital admissions per year of children with acute gastroenteritis.
  
  
  METHODS
  Quality indicators for overuse and misuse of care in the management of acute gastroenteritis based on nationally published guidelines. These include blood testing, stool studies, use of antibiotics, and use of nonrecommended antiemetic or antidiarrheal medications (hereafter referred to as nonrecommended medications).
  
  
  RESULTS
  Selected blood, stool, and rotavirus tests (overuse indicators) were performed in 85%, 46%, and 56% of children, respectively. Six percent of children received nonrecommended medications, and 26% received antibiotics (misuse indicators). Higher volumes of hospital admission for acute gastroenteritis were associated with less use of blood tests (odds ratio [OR], 0.67 [95% confidence interval {CI}, 0.50-0.89]), nonrecommended medications (OR, 0.84 [95% CI, 0.76-0.93]), and antibiotics (OR, 0.93 [95% CI, 0.86-0.99]). Children admitted to hospitals in the 25th vs 75th percentile of patient volume had a 10%, 30%, and 10% increased chance of having blood tests, nonrecommended medications, and antibiotics ordered, respectively.
  
  
  CONCLUSIONS
  In a nationally representative sample of hospitals that care for children with acute gastroenteritis, higher patient volumes were associated with greater adherence to established quality indicators. Further investigation is needed to identify the hospital characteristics driving the volume-quality relationship for this common pediatric condition.
authors: Department of Pediatrics, Children's Hospital of Philadelphia, PA 19104, USA. mcleod@email.chop.edu
authors: Lisa
authors: L
authors: McLeod
authors: Benjamin
authors: B
authors: French
authors: Dingwei
authors: D
authors: Dai
authors: Russell
authors: R
authors: Localio
authors: Ron
authors: R
authors: Keren
mesh_terms: D000208:Acute Disease; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D005759:Gastroenteritis / Q000628:therapy*; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome