title: Variation in resource use and readmission for diabetic ketoacidosis in children's hospitals.
abstract: OBJECTIVE
  We sought to characterize variation in hospital resource utilization and readmission for diabetic ketoacidosis (DKA) across US children's hospitals.
  
  
  METHODS
  The study sample included a retrospective cohort of children aged 2 to 18 years with a diagnosis of DKA at 38 children's hospitals between 2004 and 2009. The main outcomes were resource utilization as determined by total standardized cost per hospitalization, overall and non-ICU length of stay (LOS), and readmission for DKA within 30 and 365 days.
  
  
  RESULTS
  There were 24,890 DKA admissions, and 20.3% of these were readmissions within 1 year. The mean hospital-level total standardized cost was $7142 (range $4125-$11,916). The mean hospital-level LOS was 2.5 days (1.5-3.7), and the non-ICU portion was 1.9 days (0.7-2.7). The mean hospital-level readmission within 365 days was 18.7% (6.5%-41.1%) and within 30 days was 2.5% (0.0%-7.1%). Hospital bed days overall, and in particular the non-ICU portion, accounted for the majority of the total standardized cost per hospitalization (overall 57%; non-ICU 36%) and explained most of the variation in resource use. Even after adjusting for difference in patient characteristics across hospitals, widespread differences existed across hospitals in total standardized cost, LOS, and readmission rates (P < .001).
  
  
  CONCLUSIONS
  Readmission for DKA within a year of hospitalization is common. US children's hospitals vary widely in resource use, hospital LOS, and readmission rates for patients with DKA. Our study highlights the need for additional research to understand these differences and to identify the most cost-effective strategies for managing diabetes across the continuum of care.
authors.affiliation: Division of Inpatient Medicine, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington 98105, USA. joel.tieder@seattlechildrens.org
authors.forename: Joel S
authors.initials: JS
authors.lastname: Tieder
authors.forename: Lisa
authors.initials: L
authors.lastname: McLeod
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.forename: Xianqun
authors.initials: X
authors.lastname: Luan
authors.forename: Russell
authors.initials: R
authors.lastname: Localio
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mahant
authors.forename: Faisal
authors.initials: F
authors.lastname: Malik
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Karen M
authors.initials: KM
authors.lastname: Wilson
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016883:Diabetic Ketoacidosis / Q000191:economics* / Q000453:epidemiology*; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
keywords: DKA; Pediatric Research in Inpatient Settings (PRIS) network; diabetic ketoacidosis; hospitalist; readmission; type 1 diabetes mellitus