Regional and hospital variation in commonly performed paediatric otolaryngology procedures in the Netherlands: a population-based study of healthcare utilisation between 2016 and 2019

Does size matter? Hospital volume and resource use in paediatric diabetes care

AIMS

Paediatric diabetes care has become increasingly specialised due to the multidisciplinary approach and technological developments. Guidelines recommend sufficient experience of treatment teams. This study evaluates associations between hospital volume and resource use and hospital expenditure in Dutch children with diabetes.

METHODS

Retrospective cohort study using hospital claims data of 5082 children treated across 44 Dutch hospitals (2019-2020). Hospitals were categorised into three categories; small (≥20-100 patients), medium (≥100-200 patients) and large (≥200 patients). All-cause hospitalisations, consultations, technology and hospital expenditure were analysed and adjusted for age, sex, socio-economic status (SES) and hospital of treatment.

RESULTS

Fewer hospitalisations were observed in large hospitals compared to small hospitals (OR 0.48; [95% CI 0.32-0.72]; p < 0.001). Median number of yearly paediatrician visits was 7 in large and 6 in small hospitals, the significance of which was attenuated in multilevel analysis (OR ≥7 consultations: 1.89; [95%CI 0.74-4.83]; p = 0.18). Technology use varies between individual hospitals, whereas pump usage and real-time continuous glucose monitoring showed no significant differences between hospital volumes. Mean overall expenditure was highest in medium-sized centres with €6434 per patient (IQR €2555-7955); the difference in diabetes care costs was not significant between hospital patient volumes.

CONCLUSIONS

Care provision patterns vary by hospital patient volume. Large hospitals had the lowest hospitalisation rates. The use of diabetes technology was not different between hospital patient volumes. Medium-sized hospitals showed the highest overall expenditure, but diabetes care costs were similar across hospital volumes.

Unwarranted Between-hospital Variation in Mortality, Readmission, and Length of Stay of Urological Admissions: An Important Trigger for Prioritising Quality Targets

BACKGROUND

Unwarranted between-hospital variation is a persistent health care quality issue. It is unknown whether urology patients are prone to this variation.

OBJECTIVE

To examine between-hospital variation in mortality, readmission, and length of stay for all 22 urological All Patient Refined Diagnosis Related Groups (APR-DRGs).

DESIGN, SETTING, AND PARTICIPANTS

This study included administrative data from 320640 urological admissions in 99 (98%) Belgian acute-care hospitals between 2016 and 2018.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

We used hierarchical mixed-effect logistic regression models to estimate hospital-specific and APR-DRG-specific risk-standardised rates for in-hospital mortality, 30-d readmission, and length of stay above the APR-DRG-specific 90th percentile. Between-hospital variation was assessed based on the estimated variance components. Associations of outcomes with patient and hospital characteristics and time trends were examined.

RESULTS AND LIMITATIONS

Our analysis revealed important between-hospital variation in mortality, readmission, and length of stay for urological pathologies, particularly for medical diagnoses. Significant variation was shown in all three outcomes for kidney and urinary tract infections; other kidney and urinary tract diagnoses, signs, and symptoms; urinary stones and acquired upper urinary tract obstruction; and kidney and urinary tract procedures for nonmalignancy. Lowering of mortality rates in upper-quartile hospitals to the median could potentially save 41.5% of deaths in these hospitals, with the largest absolute gain for kidney and urinary tract infections and kidney and urinary tract malignancy. Limitations included a likely underestimation of readmission rates.

CONCLUSIONS

Urological patient outcomes are characterised by unwarranted between-hospital variation. We recommend improvement initiatives to prioritise kidney and urinary tract infections because of significant variation across the three outcomes and the largest potential gain in lives saved.

PATIENT SUMMARY

We found notable between-hospital variation in mortality, readmission, and length of stay for urological hospital admissions in Belgium. As much as 41.5% of deaths could potentially be avoided if underperforming hospitals improved. Targeting kidney and urinary tract infections could help reduce variation.