Kids' Inpatient Database: Empowering Scientific Discovery (Text Version)

Slide presentation from the AHRQ 2010 conference.

On September 28, 2010, Jay Berry made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (350 KB). Free PowerPoint® Viewer (Plugin Software Help).


Slide 1

Kids' Inpatient Database: Empowering Scientific Discovery

Kids' Inpatient Database: Empowering Scientific Discovery

Jay G. Berry MD MPH

Complex Care Service, Cerebral Palsy Program, Program for Patient Safety and Quality
Division of General Pediatrics, Children's Hospital Boston, Boston, MA

Slide 2

2:30 am, December 14th, 2003

2:30 am, December 14th, 2003

  • First KID Exposure:
    • Setting:
      • Pediatrics resident, on-call
      • Admitting patients with Dr. Raj Srivastava
    • Patient with hypoplastic left heart syndrome:
      • Surgical complication
      • Related to surgical team inexperience

Slide 3

2:30 am, December 14th, 2003

2:30 am, December 14th, 2003

  • First KID Exposure:
    • ICD-9 code book
    • KID 1997
    • Modeling: mortality variation among hospitals

Slide 4

2:30 am, December 14th, 2003

2:30 am, December 14th, 2003

  • First KID Exposure:
    • ICD-9 code book
    • KID 1997
    • Modeling: mortality variation among hospitals

Higher mortality rates for children undergoing surgery for hypoplastic left heart syndrome in low volume and non-teaching hospitals.

Slide 5

KID: Personal Impact

KID: Personal Impact

  • Power of large, administrative datasets to study outcomes and utilization of children with rare diseases.
  • Entrance into the world of pediatric quality of care and health services research.

Slide 6

 

My Clinical and Research Interest

My Clinical and Research Interest

  • Children with medical complexity:
    • Chronic health conditions
    • Multiple co-morbidities
  • Surgery collaboration:
    • Predict outcomes
    • Develop care plans

Image: A child on crutches with a dog is shown.

Slide 7

Predicting Outcomes

Predicting Outcomes

  • Children with medical complexity:
    • Attributes:
      • Low prevalence
      • Unique combinations of co-morbid conditions
    • Existing outcome evidence:
      • Single institution-based
      • Longitudinal data, over multiple decades

Slide 8

Improving Outcome Prediction

Improving Outcome Prediction

  • Kids' Inpatient Database:
    • Powered to study rare conditions:
      • Robust stratified sample
      • Nationally-representative
    • Elements for co-morbidity-outcome analyses:
      • Diagnoses, procedures
      • Mortality, complications
      • Inpatient utilization

Slide 9

Tracheotomy in Children

Tracheotomy in Children

  • Indication:
    • Overcome life-limiting respiratory compromise
  • Rise in patient complexity:
    • Multiple co-morbid conditions
  • Major caregiving burden:
    • Life disruption

Image: A baby with a tracheotomy tube is shown.

Slide 10

Mortality Following Tracheotomy

Mortality Following Tracheotomy

  • Existing evidence:
    • 1-3% early mortality rate
    • Single institutions
  • Mortality may be under-estimated:
    • Rising patient complexity
    • Presence of tenuous co-morbid conditions

Slide 11

Tracheotomy Mortality Analysis

Tracheotomy Mortality Analysis

  • Kids' Inpatient Database 2006:
    • Tracheotomy ICD-9 codes
    • In-hospital mortality
  • Partition, Regression Tree Modeling:
    • Demographic and co-morbid conditions
    • Characteristic combinations and mortality

Slide 12

KID 2006 4,751 Tracheotomy Hospitalizations

KID 2006
4,751 Tracheotomy Hospitalizations

Clinical ConditionPercentage
Neurological Impairment46%
Chronic Lung Disease44%
Upper Airway Anomaly28%
Congenital Heart Disease19%
Prematurity13%
≥ 2 Clinical Conditions67%

 

Slide 13

Tracheotomy Mortality Regression Tree

Tracheotomy Mortality Regression Tree

Image: A tree chart depicts the different mortality rates that children undergoing tracheotomy experience, depending on which co-morbid conditions they possess. It consist of the following:

  • All Patients Mortality = 9%
    • Congenital Heart Disease (-) 6%
      • Prematurity (-) 5%
        • Airway Anomaly (+) 2%
        • Airway Anomaly (-) 6%
      • Prematurity (+) 17%
    • Congenital Heart Disease (+) 19%
      • Airway Anomaly (+) 7%
      • Airway Anomaly (-) 27%
        • Age ≥ 1 year 12%
        • Age < 1 year 30%

Slide 14

Tracheotomy Mortality Regression Tree

Tracheotomy Mortality Regression Tree

Image: A tree chart depicts the different mortality rates that children undergoing tracheotomy experience, depending on which co-morbid conditions they possess. The tree chart is simular to the chart in Slide 13, but sections are darkened and muted. Only the following sections are highlighted to be visible:

  • All Patients Mortality = 9%
    • Congenital Heart Disease (-) 6%
      • Prematurity (-) 5%
        • Airway Anomaly (+) 2%

Slide 15

Tracheotomy Mortality Regression Tree

Tracheotomy Mortality Regression Tree

Image: A tree chart depicts the different mortality rates that children undergoing tracheotomy experience, depending on which co-morbid conditions they possess. The tree chart is simular to the chart in Slide 13, but sections are darkened and muted. Only the following sections are highlighted to be visible:

  • All Patients Mortality = 9%
    • Congenital Heart Disease (+) 19%
      • Airway Anomaly (-) 27%
        • Age < 1 year 30%

Slide 16

KID Impact for Children Undergoing Tracheotomy

KID Impact for Children Undergoing Tracheotomy

  • Bringing evidence to the bedside:
    • Individualizing outcome prediction
    • Counseling families of risk and benefit
    • Increased attention to at-risk patients

Slide 17

Keep it coming!

Keep it coming!

  • The HCUP-KID empowers scientific discovery that is leading to improvements in care for children!
  • Future data element expansion will enhance its power!

Slide 18

Thank you.

Thank you

  • AHRQ and the HCUP team
  • Pamela Owens and Anne Elixhauser
  • Raj Srivastava and Don Goldmann
Current as of December 2010
Internet Citation: Kids' Inpatient Database: Empowering Scientific Discovery (Text Version). December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2010/berry/index.html