Variations in Management of Common Inpatient Pediatric Illnesses

Hospitalists and Community Pediatricians

There is a lack of data comparing the quality of care given by pediatricians who mainly practice in hospitals with the quality of care given by those who practice in the community. The purpose of this study was to assess whether pediatric hospitalists use evidence-based therapies and tests more consistently, and use unproven therapies and tests less often, when compared with pediatricians practicing in the community. Two hundred thirteen pediatric hospitals and 352 community pediatricians responded to a national, random sample survey of reported frequency of use of diagnostic tests and therapies for common inpatient pediatric illnesses. Responses were compared in univariate and multivariable logistic regression analyses.

Key Findings

  • Hospitalists were significantly more likely than community pediatricians to report often or almost always using evidence-based therapies for asthma in the first 24 hours of hospitalization.
  • Hospitalists were more likely to report obtaining the recommended renal ultrasound and voiding cystourethrogram after the first urinary tract infection.
  • Hospitalists also were significantly more likely to report rarely or never using the following therapies of unproven benefit: levalbuterol, inhaled steroid therapy, and oral steroid therapy for bronchiolitis; stool culture and rotavirus testing for gastroenteritis; and ipratropium after 24 hours of hospitalization for asthma.