"The original medical data system, called DRGs for Diagnosis-Related Groups, was built for adults, but kids are different," says lead author Aileen Sedman, M.D., who led the team while she was associate chief of clinical affairs at the U-M Health System and who now works as a medical advisor for NACHRI. "Now that we can look at these data in a child-specific way, we have a tremendous opportunity to improve quality."
Sedman and her colleagues started by examining Mott's performance in the NACHRI database. They looked at how Mott's average hospital stay compared with the national average in a broad range of medical conditions. Such comparisons are made possible through the use of all-patient refined diagnosis-related groups, or APR-DRGs, developed by NACHRI in cooperation with the 3M Corporation to reflect children's health problems.
U-M began using APR-DRGs to analyze Mott patient care data in 1998. The next year, Sedman's team in Clinical Affairs found that Mott had an above-average hospital stay for children who had been hospitalized for an asthma attack but had been classed in the least-severe category (level 1) of inpatient asthma patients. The more severely ill asthma patients had shorter-than-average stays.
At Mott, level 1 patients are treated on a general medical service, while more severe cases are treated on a service run by pediatric pulmonologists. Realizing this, the team looked for ways to redesign care on the general service to help children get home sooner and prevent further attacks.
For instance, the pulmonologists developed standardized orders that doctors and nurses could follow for each patient, so that they could adjust levels of inhaled asthma-calming medications throughout the
Contact: Kara Gavin
University of Michigan Health System