Common Childhood Nausea and Diarrhea Lead to Wide Treatment and Cost Disparities Across U.S.

In a new study publishing in the December issue of Pediatrics, the common childhood condition of acute gastroenteritis (AGE), or routine nausea, vomiting and diarrhea, is examined across multiple U.S. hospitals and 188,873 patients aged 6 months to 6 years.


Even as Obama’s administration struggles with healthcare reform, medical researchers around the country are publishing studies that exemplify “less can be more” in terms of how much care is too much, how much is too little, what should be implemented as “standard care” for common conditions, and what the cost and risk burdens are for patients, providers, hospitals and insurance companies when standard care protocols for simple conditions are not adhered to.

In the new study “Hospital Adherence to the Standard of Care for Acute Gastroenteritis,” publishing in the December issue of Pediatrics and appearing early online as of Monday, November 2, the common childhood condition of acute gastroenteritis (AGE), or routine nausea, vomiting and diarrhea, is examined across multiple U.S. hospitals and 188,873 patients aged 6 months to 6 years.

This is the largest multi-institutional study of AGE care at children’s hospitals. Through evaluation of nationally recommended resource utilization, the study demonstrates great variation in care delivered for this very routine condition which so many young children commonly experience in multiple episodes each year.

AGE is one of the most common health problems affecting children in the U.S., causing 1.5 million outpatient visits, and 220,000 hospitalizations per year.

In spite of published standards and CDC guidelines for addressing AGE, there is no uniform implementation of those standards, resulting in potentially $1 billion in direct medical costs that could be avoided. The researchers suggest that if AGE care were implemented according to simple standards, related hospital admission rates would decrease by 45%.

From the study data, some hospitals are more likely to routinely perform additional non-recommended tests, while some do not. Those hospitals that do not, as recommended by national guidelines, demonstrated 50% lower charges without any measurable effect on patient outcomes.

Of the nearly 200,000 patient records examined, 92% were seen in Emergency Departments or observation settings, while 8% were admitted to hospitals. Average ED and observation unit charges were $591, and average admission charges were $4,188.

Study principal investigator Joel S. Tieder, MD, MPH, inpatient pediatrician and hospitalist at Seattle Children’s Hospital, suggests this data exemplifies many other common conditions, showing wide levels of care being provided even for those conditions where standard practices have already been determined and established.

“More is not necessarily better,” says Tieder. “More care leads to more costs, but there’s not necessarily any benefit to the patient. It’s vital to have clearly published standards and to implement them, across facilities and providers.” He adds, “Those hospitals that do practice care standards provide the highest quality care, while at the same time using fewer resources. Despite evidence that most hospital care for AGE is avoidable, especially after proper initiation of simple Oral Rehydration Therapy, AGE unnecessarily remains one of the most common reasons for pediatric ED visits and hospitalizations.” He asks, “Why should we subject these patients to needle sticks for tests or intravenous fluids when simply drinking oral rehydration according to standards makes them feel better faster, and also subjects them to less risk, pain and cost?”

“Healthcare reform is looking at this very issue, trying to standardize care that is indicated and received, and manage the utilization of resources. Interestingly for AGE, we find that Third World countries have a great deal to teach us in caring for this simple childhood condition. Lacking the technologies of the U.S., the ‘back to basics’ care offered elsewhere reminds us that for conditions like AGE, sometimes less is more.”

Seattle Children’s Hospital has a Clinical Effectiveness Team, whose goal is to provide the best care in efficient and standardized ways according to evidence-based protocols.

For interviews with Dr. Joel Tieder, please contact:

Teri Thomas

(206) 987-5213

teri.thomas@seattlechildrens.org

For a copy of the study PDF, please contact:

American Academy of Pediatrics (AAP); study published early online in Pediatrics on Mon. 11/2/09, ahead of Dec. 2009 print issue (847) 434-7131.

About Seattle Children’s

Consistently ranked as one of the best children’s hospitals in the country by U.S. News & World Report, Seattle Children’s serves as the pediatric and adolescent academic medical referral center for the largest landmass of any children’s hospital in the country (Washington, Alaska, Montana and Idaho). For more than 100 years, Seattle Children’s has been delivering superior patient care while advancing new treatments through pediatric research. Seattle Children’s serves as the primary teaching, clinical and research site for the Department of Pediatrics at the University of Washington School of Medicine. The hospital works in partnership with Seattle Children’s Research Institute and Seattle Children’s Hospital Foundation. For more information, visit www.seattlechildrens.org or follow us on Twitter or Facebook.