Association of Models of Care for Kawasaki Disease With Utilization and Cardiac Outcomes

Nathan M. Money, Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah.
Matthew Hall, Department of Analytics, Children's Hospital Association, Lenexa, Kansas.
Ricardo A. Quinonez, Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Eric R. Coon, Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah.
Adriana H. Tremoulet, Department of Pediatrics, Rady Children's Hospital and University of California San Diego, San Diego, California.
Jessica L. Markham, Section of Pediatric Hospital Medicine, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
Guliz Erdem, Section of Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
Nisha Tamaskar, Division of Hospital Medicine, Children's National Hospital, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia.
Kavita Parikh, Division of Hospital Medicine, Children's National Hospital, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia.
Hannah C. Neubauer, Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
John B. Darby, Section of Pediatric Hospital Medicine, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Sowdhamini S. Wallace, Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.

Document Type

Journal Article

Publication Date

2-23-2022

Journal

Hospital pediatrics

DOI

10.1542/hpeds.2021-006364

Abstract

OBJECTIVES: Describe the prevalence of different care models for children with Kawasaki disease (KD) and evaluate utilization and cardiac outcomes by care model. METHODS: Multicenter, retrospective cohort study of children aged 0 to 18 hospitalized with KD in US children's hospitals from 2017 to 2018. We classified hospital model of care via survey: hospitalist primary service with as-needed consultation (Model 1), hospitalist primary service with automatic consultation (Model 2), or subspecialist primary service (Model 3). Additional data sources included administrative data from the Pediatric Health Information System database supplemented by a 6-site chart review. Utilization outcomes included laboratory, medication and imaging usage, length of stay, and readmission rates. We measured the frequency of coronary artery aneurysms (CAAs) in the full cohort and new CAAs within 12 weeks in the 6-site chart review subset. RESULTS: We included 2080 children from 44 children's hospitals; 21 hospitals (48%) identified as Model 1, 19 (43%) as Model 2, and 4 (9%) as Model 3. Model 1 institutions obtained more laboratory tests and had lower overall costs (P < .001), whereas echocardiogram (P < .001) and immune modulator use (P < .001) were more frequent in Model 3. Secondary outcomes, including length of stay, readmission rates, emergency department revisits, CAA frequency, receipt of anticoagulation, and postdischarge CAA development, did not differ among models. CONCLUSIONS: Modest cost and utilization differences exist among different models of care for KD without significant differences in outcomes. Further research is needed to investigate primary service and consultation practices for KD to optimize health care value and outcomes.

Department

Pediatrics

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