Hospital Care Varies Greatly for Children With Urinary Tract Infections

Standardizing Care May Improve Quality, Reduce Hospital Stays

Tuesday, April 21, 2009

More than 45,000 infants and children in the United States are hospitalized each year for urinary tract infections, but a new study reveals significant variability across hospitals in treatment and outcomes.

The findings of the study provide an opportunity to eliminate potential waste in the healthcare system and to engage in quality improvement efforts for this common condition, according to study co-authors Patrick Conway, MD, a pediatrician at Cincinnati Children’s Hospital Medical Center, and Ron Keren, MD, a pediatrician at The Children’s Hospital of Philadelphia.

“The variability across hospitals represents an opportunity for benchmarking and standardization of care,” says Dr. Conway. “Decreased length of stay and costs associated with clinical practice guidelines support their implementation.”

The study is the first large-scale investigation of variability in urinary tract infection (UTI) management and was published online March 26 in the Journal of Pediatrics.

“It’s astonishing that in this day and age children with the same common condition—urinary tract infections—are being managed so differently from one hospital to the next,” says Dr. Keren, the director of the Center for Pediatric Clinical Effectiveness at The Children’s Hospital of Philadelphia.

Drs. Conway and Keren studied 20,892 children between the ages of 1 month and 12 years old hospitalized at one of 25 children’s hospitals between 1999 and 2004. They found significant variability among hospitals in terms of length of stay, costs, readmission rates and tests performed.

They also found that certain patient and hospital factors explained some of these differences. For example, older children had shorter length of stay and lower costs, and were less likely to undergo imaging and to be admitted to the intensive care unit. On the other hand, African-American and Latino patients had longer length of stay and higher costs, and were more likely to undergo imaging and to be admitted to the intensive care unit. Perhaps most importantly, length of stay and costs were lower at hospitals that used clinical practice guidelines for the management of UTI.

“Patients should not receive different care based on where they live and the hospital they go to,” says Dr. Conway. “Clinical practice guidelines, such as those adopted by Cincinnati Children’s, have been shown to decrease variability of care, length of stay and costs. The healthcare system in the United States needs to strive to deliver consistent, high quality care, based on evidence, to all children.”

Dr. Conway received a training grant from the Robert Wood Johnson Clinical Scholars Program at the University of Pennsylvania, and Dr. Keren received grant support from the National Institutes of Health. Dr. Conway began his study when he was a hospitalist at The Children’s Hospital of Philadelphia and a Robert Wood Johnson Clinical Scholar at the University of Pennsylvania.

About Cincinnati Children’s Hospital Medical Center

Cincinnati Children’s Hospital Medical Center is one of America’s top three children’s hospitals for general pediatrics and is highly ranked for its expertise in digestive diseases, respiratory diseases, cancer, neonatal care, heart care and neurosurgery, according to the annual ranking of best children's hospitals by U.S. News & World Report. One of the three largest children’s hospitals in the U.S., Cincinnati Children’s is affiliated with the University of Cincinnati College of Medicine and is one of the top two recipients of pediatric research grants from the National Institutes of Health.

For its achievements in transforming healthcare, Cincinnati Children’s is one of six U.S. hospitals since 2002 to be awarded the American Hospital Association-McKesson Quest for Quality Prize for leadership and innovation in quality, safety and commitment to patient care. The hospital is a national and international referral center for complex cases, so that children with the most difficult-to-treat diseases and conditions receive the most advanced care leading to better outcomes. Additional information can be found at www.cincinnatichildrens.org.

About The Children’s Hospital of Philadelphia

The Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children’s Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.