Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

Authors

  • Christopher P. Landrigan MD, MPH,

    Corresponding author
    1. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
    2. Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
    • Brigham and Women's Hospital, 221 Longwood Ave., 4th floor, Boston, MA 02115
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    • FAX: 617-732-4015

  • Patrick H. Conway MD, MPH,

    1. Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
    2. Robert Wood Johnson Foundation Clinical Scholar Program, University of Pennsylvania, Philadelphia, Pennsylvania
    3. Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    4. Center for Health Care Quality and Division of General Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio
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  • Erin R. Stucky MD,

    1. Children's Hospital and Health Center, University of California San Diego School of Medicine, San Diego, California
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  • Vincent W. Chiang MD,

    1. Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
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  • Mary C. Ottolini MD, MPH

    1. Children's National Medical Center, George Washington University School of Medicine, Washington, DC
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  • Competing interests: CPL has served as a paid consultant to the District Health Boards of New Zealand, performing an assessment of current working conditions for junior doctors in New Zealand, and providing recommendations on how to improve the safety of scheduling practices. CPL has also received honoraria at several academic medical institutions and conferences to speak about the PRIS research network and evidence based medicine in the care of hospitalized children. No other authors have conflicts of interest to report.

Abstract

BACKGROUND:

Undesirable practice variation remains a major concern with the quality of the healthcare system. While care in pediatric hospitalist systems has been demonstrated to be efficient, neither the quality of care nor determinants of variation in pediatric hospitalist systems are well understood.

OBJECTIVE:

To measure variation in pediatric hospitalists' reported use of common inpatient therapies, and to test the hypothesis that variation in reported use of proven therapies is lower than variation in reported use of unproven therapies.

DESIGN AND MEASUREMENTS:

We conducted a survey of pediatric hospitalists in the US and Canada. Respondents reported their frequency of using 14 therapies in the management of common conditions. Each therapy was determined to be of proven or unproven effectiveness using published critical appraisals. Variation in reported use of proven and unproven therapies was compared.

RESULTS:

67% (213/320) of surveyed individuals participated. Little variability existed in reported use of albuterol and corticosteroids in asthma (4-6% of respondents reported not often using them) and systemic dexamethasone in bronchiolitis (12% of respondents reported using it more than rarely). Moderate to high variation existed in reported use of all other therapies studied. Variation in reported use of proven therapies was significantly less than variation in reported use of unproven therapies (15.5 ± 12.5% vs. 44.6 ± 20.5%).

CONCLUSIONS:

Substantial variation exists in hospitalists' reported management of common pediatric conditions. Variation is significantly lower for strongly evidence-based therapies. To decrease undesirable variation in care, a stronger evidence base for inpatient pediatric care must be built. Journal of Hospital Medicine 2008;3:292–298. © 2008 Society of Hospital Medicine.

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