Child/Adolescent Health

Pediatric hospitalists are more likely than community pediatricians to use evidence-based care for hospitalized children

Pediatric hospitalists, who specialize in caring for hospitalized children, are more likely than community pediatricians to follow recommended care guidelines, according to a new study. They are also less likely to use therapies and tests with unproven benefits. Researchers found that hospitalists and community pediatricians made significantly different management decisions for 75 percent of the 48 tests and therapies evaluated. These care differences persisted even after controlling for physician sociodemographics, years out of residency, training, and hospital practice type.

The researchers conducted a national survey of hospitalists and a random sample of community pediatricians asking about their use of 48 diagnostic tests and therapies for several common pediatric illnesses. A total of 213 hospitalists and 352 community pediatricians responded. Hospitalists were nearly 4 times more likely to report often or almost always using the following evidence-based therapies for asthma: albuterol and ipratropium in the first 24 hours of hospitalization. For an infant's first urinary tract infection, hospitalists were 3 to 4 times more likely to obtain the recommended renal ultrasound and voiding cystourethrogram.

Hospitalists were significantly more likely than community pediatricians 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 routine gastroenteritis; and use of ipratropium after 24 hours for hospitalization for asthma. The study was supported in part by the Agency for Healthcare Research and Quality (HS13333).

See "Variations in management of common inpatient pediatric illnesses: Hospitalists and community pediatricians," by Patrick H. Conway, M.D., Sarah Edwards, B.A., Erin R. Stucky, M.D., and others, in the August 2006 Pediatrics 118(2), pp. 441-448.

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