Geisel Researchers to Receive $2.6 Million Award to Study Pediatric Hospital Admissions
A team of researchers at Dartmouth’s Geisel School of Medicine, led by JoAnna Leyenaar, MD, PhD, MPH, will receive a $2.6 million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to compare the effectiveness of direct admission and admission through emergency departments (EDs) for hospitalized children.
In a landmark report, the Institute of Medicine described the U.S. emergency medical system as “overburdened, fragmented,” and “at the breaking point.” A major factor in this crisis is the way that EDs have increasingly served as gateways for hospital admissions over the past 20 years—contributing to ED crowding and associated wait times. In fact, of the 1.5 million unplanned pediatric hospitalizations that occur each year, 75 percent now come from EDs.
The remaining 25 percent occur through direct admission from the community—from patients’ homes or from primary care or specialty clinics, and are typically facilitated by direct conversations between community-based and hospital-based healthcare providers.
But more purposefully designed direct admission systems are needed in hospitals to receive referrals from physicians in the community. And while ED utilization patterns have been well-studied, research comparing the effectiveness of direct and ED admissions is lacking, especially in children.
“Direct admission may offer benefits for both patients and healthcare systems, including reduced ED volumes, improved coordination between outpatient and hospital-based healthcare providers, and improved family experience of care,” says Leyenaar, an associate professor of pediatrics at Geisel and of The Dartmouth Institute for Health Policy and Clinical Practice.
The overall goals of the project will be to: implement pediatric direct admission systems at three different hospitals; compare the timeliness of healthcare delivery for children who are admitted directly and through EDs; determine which patient populations achieve the greatest benefits from direct admission; and identify barriers and facilitators of successful implementation.