Benefits and Cost-Effectiveness of a Pediatric Hospitalist Service : a Stepped Wedge Quality Improvement Trial

NCT02690623 | Withdrawn

• 1 other identifier: HSC-MS-15-0978
• Study Type: interventional
• Target: N/A
• Locations: 1 country
• Sites: 1

Brief Summary

Background. Hospitalists predominantly engaged in inpatient care constitute a fundamental, poorly assessed change in medical care. The University of Texas Houston Pediatrics Department is developing a Hospitalist Division to staff Children's Memorial Hermann Hospital. Demonstration of its benefits and cost-effectiveness is important to secure adequate, sustained hospital or 3rd-party reimbursement. Design. Prospective step wedged quality improvement (QI) study with pediatric hospitalists sequentially assuming 24/7 responsibility for each of the 4 pediatric inpatient services over 2-3 years. This design allows within- and between-group analyses and is particularly desirable for evaluating interventions likely to be beneficial that will be given stepwise to an increasing % of patients. Intervention. Faculty of the new Pediatric Hospitalist Division will initially become responsible 24/7 for 1-2 of the 4 services now staffed by the General Pediatric Division. Currently, each pediatric service admits every other patient without regard to diagnosis, resulting in quasi-random patient assignment. Outcomes: Total hospital days (including 30-day readmissions); intubation; pediatric intensive care unit (ICU) admissions; parent, nurse, and resident satisfaction; and costs assessed using state-of-the-art methods and expressed from the health system, medical school, and hospital perspectives. Hypotheses. Hospitalists will improve clinical outcomes and parent, nurse, and resident satisfaction and be cost-effective (primary outcome), assessed by net cost or savings per hospital day prevented (health system perspective). Analyses. Frequentist and Bayesian analyses to assess the probability of benefit and of cost-effectiveness.

Conditions

Hospitalism in Children

Keywords

hospitalist; pediatric inpatient care

Outcome Measures

Primary Outcomes (1)

• Net cost or savings per hospital day prevented assessed from the health system perspective

  The incremental cost-effectiveness ratio will be computed by by subtracting the mean cost per patient in the hospitalist group from the mean cost per patient in the general pediatrics group (from health system perspective) and dividing it by the hospital days avoided.

  up to 30 months

Secondary Outcomes (6)

• Hospital days

  up to 30 months

• Number of participants with severe deterioration as assessed by chart review and claims data.

  up to 30 months

• Days with diversion

  up to 30 months

• Parent satisfaction at discharge

  up to 30 months

• Nurse and resident satisfaction

  Through study completion, an average of 2.5 years

Study Arms (2)

Pediatric hospitalist program

EXPERIMENTAL

As currently planned, hospitalist services will involve an in-house hospitalist at all hours. The attending hospitalist on each hospitalist service will make morning rounds on weekdays and be present supervising the residents or providing care throughout the day. A different hospitalist will cover at night. On weekends, one hospitalist will cover up to 2 services each day. None will work for more than 25 hours at a stretch.

Other: Pediatric hospitalist program

General Pediatric Inpatient Services

ACTIVE COMPARATOR

The attending pediatrician on each service conducts daily morning rounds on weekdays, supervises the students and house staff and is available to the residents by phone or in person during the day. On some afternoons the attending physician may be responsible for supervising care in a pediatric clinic. On weeknights, an on-call pediatrician is available to the residents by phone. On weekends two on-call pediatricians make rounds, supervise the residents, and take call from home for the 4 services. Each service usually maintains 10-20 patients at a time and generally accepts 8-12 new admissions per admitting day. This approach on the General Pediatric Services will not be changed materially as hospitalists assume responsibility for one or more of the 4 services.

Other: General Pediatric Inpatient Services

Interventions

Pediatric hospitalist program OTHER

In-house hospitalists available at all hours

Pediatric hospitalist program

General Pediatric Inpatient Services OTHER

Inpatient care by general pediatrics faculty

General Pediatric Inpatient Services

Eligibility Criteria

• Age: Up to 18 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Children 18 years and younger admitted to the 4 pediatric inpatient services (including those on observation status) at Children's Memorial Hermann Hospital

You may not qualify if:

• Patients who are first admitted to the pediatric ICU will not be considered enrolled in the study until they are transferred to the pediatric service.

Sponsors & Collaborators

• The University of Texas Health Science Center, Houston: lead

Study Sites (1)

The University of Texas Medical School at Houston

Houston, Texas, 77030, United States

Location

Study Officials

• Elenir BC Avritscher, MD, PhD, MBA

  The University of Texas Medical School at Houston

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: January 19, 2016
• First Posted: February 24, 2016
• Study Start: June 1, 2016
• Primary Completion: July 1, 2018
• Study Completion: January 1, 2019
• Last Updated: March 21, 2018

Record last verified: 2018-03

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)