Table 3.
Associations between Degree of Hospital-Level Diagnostic Test Use, LOS and Return Visit Outcomesa
| Hospital-Level Resource Utilization (Tertile)
|
||||||
|---|---|---|---|---|---|---|
| Unadjusted Analysis | Adjusted Analysisb | |||||
|
|
||||||
| Low | Moderate | High | Low | Moderate | High | |
| LOS | ||||||
| Range of Hospital-Level Medians | 3–7 days | 2–6.5 days | 3.5–6 days | N/A | N/A | N/A |
| % difference (95% CI)c | REF | 0.2% (−13.8%, 16.4%) | 16.4% (2.3%, 32.4%) | REF | −0.8% (−14.4%, 14.9%) | 13.9% (−0.7%, 30.6%) |
| p-value | — | 0.98 | 0.02 | — | 0.91 | 0.06 |
|
| ||||||
| 30-Day Revisit Rate | ||||||
| All-Cause Revisit Rate | 6.2–38.5% | 17.7–33.3% | 10.3–36.9% | N/A | N/A | N/A |
| OR (95% CI) | REF | 1.10 (0.83,1.47) | 0.97 (0.72,1.31) | REF | 1.19 (0.93,1.52) | 1.07 (0.82,1.39) |
| p-value | — | 0.49 | 0.85 | — | 0.16 | 0.63 |
| Inpatient/Observation Readmissions Only | 0–35.9% | 12.8–25.9% | 10.3–31.0% | |||
| OR (95% CI) | REF | 1.01 (0.72, 1.42) | 0.88 (0.62, 1.25) | REF | 1.08 (0.80, 1.45) | 0.93 (0.68, 1.28) |
| p-value | — | 0.97 | 0.48 | — | 0.63 | 0.66 |
| ED revisits only | 0–12.2% | 0–15.7% | 0–13.2% | |||
| OR (95% CI) | REF | 1.40 (0.77, 2.55) | 1.35 (0.76, 2.39) | REF | 1.46 (0.76, 2.78) | 1.50 (0.84, 2.68) |
| p-value | — | 0.27 | 0.30 | — | 0.25 | 0.17 |
a
30-day revisit outcomes analyzed by mixed effects logistic regression, with random intercept for hospital. LOS outcome analyzed by mixed effects negative binomial regression, with random intercept for hospital.
b
LOS analyses adjusted for patient age, gender race, Hispanic ethnicity, type of insurance (public, private, other), hospital region (Midwest, Northeast, South, West), and average daily census. 30-day re-visit analysis additionally adjusted for hospital average pediatric LOS weight.
c
LOS interpreted as percent mean difference in outcome (from low resource utilization). OR = odds ratio, CI = confidence interval.