Friday, October 9, 2015

Hospital Variation on Care Utilization by Children with Medical Complexity: Does It Happen and What Do We Do about It?


By: Lewis First, MD, MS; Editor-in-Chief      

          Thanks to the information we can get from payer claim databases, we can learn a lot about variations in care delivery regarding different patient populations. One of those populations is the group of children with medical complexity who receive care daily at our children’s hospitals.  So how consistent is the care delivery across hospitals? Ralston et al. (doi: 10.1542/peds.2014-3920), in an article being released this month in our journal, performed a retrospective population-based observational cohort study that examined payer claims of all children from 1 month to 18 years with medical complexity in Maine, New Hampshire and Vermont.  Sadly there is more variation in care across the 6 hospitals studied in these states than one might suspect.  Where are these variations occurring?  Virtually everywhere--inpatient, outpatient, in intensive care units, and in the emergency department.  Even use of ancillary tests like radiology showed substantive variation.
So what does a study like this suggest?  Drs. Thomson and Shah offer a commentary on variability in health care utilization that accompanies this study and suggest how we can learn from the results being shared in this and other care variation studies that our journal and many others seem to publishing on a frequent basis.  We encourage you to read both the study and commentary and gain a better understanding of how this data might identify best practices for these patients that can then be shared and standardized across hospitals and across states. \
 If your state has an all-payer claims database, you might want to explore what that database is saying about your utilization rates and compare them to the data in this study. If the focus of care nowadays is on managing populations with high quality and lower cost, it is studies like this one that can set the stage to make that happen. 

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