Factors Associated with Variability in Outcomes for Children Hospitalized with Urinary Tract Infection

Objectives

To describe the variability in outcomes and care processes for children hospitalized for urinary tract infection (UTI), and to identify patient and hospital factors that may account for variability.

Study design

Retrospective cohort of children 1 month to 12 years of age hospitalized for UTI at 25 children's hospitals from 1999 to 2004. We measured variability in length-of-stay (LOS), cost, readmission rate, intensive care unit admission, and performance of renal ultrasound and voiding cystourethrogram and identified patient and hospital factors associated with these outcomes.

Results

The cohort included 20 892 children. There was significant variation in outcomes and processes of care across hospitals (eg, mean LOS, 2.1-5.0 days; patients with both imaging tests performed, 0.3%-72.9%). Older children had shorter LOS and were less likely to undergo imaging. Patients hospitalized at high volume hospitals were more likely to undergo imaging. Hospitals with high percentage of Medicaid patients had longer LOS and were less likely to perform imaging tests. Hospitals with a clinical practice guideline for UTI had shorter LOS and decreased costs per admission.

Conclusions

The variability across hospitals may represent opportunities for benchmarking, standardization, and quality improvement. Decreased LOS and costs associated with clinical practice guidelines support their implementation.

Abbreviations: CPG, Clinical practice guideline, ICD-9, International Classification of Diseases, Ninth Revision, ICU, Intensive care unit, LOS, Length-of-stay, OR, Odds ratio, PHIS, Pediatric Health Information System, UTI, Urinary tract infection, VCUG, Voiding cystourethrogram