PMID- 30646280 OWN - NLM STAT- MEDLINE DCOM- 20190930 LR - 20200309 IS - 2574-3805 (Electronic) IS - 2574-3805 (Linking) VI - 1 IP - 8 DP - 2018 Dec 7 TI - Adverse Events and Patient Outcomes Among Hospitalized Children Cared for by General Pediatricians vs Hospitalists. PG - e185658 LID - 10.1001/jamanetworkopen.2018.5658 [doi] LID - e185658 AB - IMPORTANCE: Pediatric hospital medicine is a relatively new and growing specialty. However, research remains inconclusive on outcomes for inpatients cared for by pediatric hospitalists compared with those cared for by general pediatricians. OBJECTIVE: To analyze outcomes, adverse events (AEs), and types of AEs associated with care provided for pediatric patients by hospitalists vs general pediatricians. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the medical records of a US urban academic children's hospital comprising 1423 hospitalizations between January 1, 2009, and August 31, 2015, for 57 diagnoses of patients cared for by either a hospitalist or general pediatrician. General pediatricians worked primarily in the hospital's outpatient clinic, serving a few inpatient weeks per year, and were not the patients' primary care physician. Data analysis was performed from July 1, 2017, to October 10, 2018. MAIN OUTCOMES AND MEASURES: Outcomes were length of stay, total costs, 30-day readmission rates, and AEs. Adverse events were documented by International Classification of Diseases, Ninth Revision, Clinical Modification codes determined by review of medical records. Adverse event categories were drug events, infections, and device-related AEs. Generalized linear models were used to analyze patient outcomes, with standard errors clustered by physician. Models were adjusted for patient characteristics, including Chronic Condition Indicators. Models were estimated with and without adjustment for physician characteristics. RESULTS: The data set contained 1423 hospitalizations among 726 female patients and 697 male patients (mean [SD] age, 6.1 [6.3] years). Hospitalists cared for 870 patients, and general pediatricians cared for 553 patients. Among the physicians, there were 57 women and 38 men; physicians were a mean (SD) 11.1 (8.1) years out of medical school. Patients cared for by general pediatricians were younger than those cared for by hospitalists (mean [SD] age, 5.4 [6.0] vs 6.5 [6.4] years; P = .001) but had similar mean (SD) Chronic Condition Indicator scores (1.5 [1.0] vs 1.5 [1.0]). A total of 33 of 56 general pediatricians (58.9%) and 24 of 39 hospitalists (61.5%) were women (P = .006), and general pediatricians were in practice twice as long as hospitalists on average (mean [SD], 16.0 [10.3] vs 7.9 [3.8] years out of medical school; P < .001). In multivariate models adjusting for patient-level features, there were no significant differences between general pediatricians and hospitalists for mean length of stay (4.7 vs 4.6 days), total costs ($14 490 vs $15 200), and estimated 30-day readmission rate (8.9% vs 6.4%), and results were similar with adjustments for physician characteristics. Device-related AEs were higher among hospitalists (3.0% vs 1.1%; odds ratio, 0.34; 95% CI, 0.12-1.00); this association became nonsignificant after adjusting for physician experience. CONCLUSIONS AND RELEVANCE: General pediatrician and hospitalist inpatient care had similar length of stay, total costs, and readmission rates. However, AEs differed between hospitalists and general pediatricians, with device-related AEs more common among hospitalists, which may be associated with hospitalists' fewer years in practice. Such findings can inform hospitals in planning their inpatient staffing and patient safety oversight. FAU - Atkinson, Mariam Krikorian AU - Atkinson MK AD - Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts. FAU - Schuster, Mark A AU - Schuster MA AD - Kaiser Permanente School of Medicine, Pasadena, California. FAU - Feng, Jeremy Y AU - Feng JY AD - Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts. AD - Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston. FAU - Akinola, Temilola AU - Akinola T AD - Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts. FAU - Clark, Kathryn L AU - Clark KL AD - Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts. FAU - Sommers, Benjamin D AU - Sommers BD AD - Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts. AD - Division of General Medicine & Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20181207 PL - United States TA - JAMA Netw Open JT - JAMA network open JID - 101729235 SB - IM DRIN- JAMA Netw Open. 2018 Dec 7;1(8):e185686. PMID: 30646273 EIN - JAMA Netw Open. 2019 Jan 4;2(1):e187783. PMID: 30681702 MH - Child MH - Child, Preschool MH - Cross Infection/*epidemiology MH - Cross-Sectional Studies MH - Delivery of Health Care/statistics & numerical data MH - Drug-Related Side Effects and Adverse Reactions/*epidemiology MH - Equipment and Supplies/adverse effects/statistics & numerical data MH - Female MH - Hospitalists/*statistics & numerical data MH - Hospitalization/*statistics & numerical data MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - Pediatricians/*statistics & numerical data MH - Quality of Health Care MH - Tertiary Care Centers/statistics & numerical data MH - Treatment Outcome PMC - PMC6324330 COIS- Conflict of Interest Disclosures: Dr Sommers reported receiving grants from REACH Healthcare Foundation, the Commonwealth Fund, and the Robert Wood Johnson Foundation; nonfinancial support from Institute for Medicaid Innovation and Milbank Memorial Fund; and personal fees from American Economic Journal, AcademyHealth, and Health Research & Educational Trust outside the submitted work. No other disclosures were reported. EDAT- 2019/01/16 06:00 MHDA- 2019/10/01 06:00 PMCR- 2018/12/07 CRDT- 2019/01/16 06:00 PHST- 2019/01/16 06:00 [entrez] PHST- 2019/01/16 06:00 [pubmed] PHST- 2019/10/01 06:00 [medline] PHST- 2018/12/07 00:00 [pmc-release] AID - 2717563 [pii] AID - zoi180242 [pii] AID - 10.1001/jamanetworkopen.2018.5658 [doi] PST - epublish SO - JAMA Netw Open. 2018 Dec 7;1(8):e185658. doi: 10.1001/jamanetworkopen.2018.5658.