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Master's Professional Reports Abstract

The Role of a Children's Hospital in the New Health Care Marketplace: A Study of Asthma in King County, Washington

Community hospitals in King County, WA, are expanding their pediatric services and competing with Children's Hospital and Medical Center (CHMC) in Seattle, the regional university-affiliated, tertiary care pediatric hospital, on the basis of providing comparable care at lower costs. To determine whether CHMC can compete with the local community hospitals, length of stay, a determinant of cost, was examined for thirteen of the most frequent discharge diagnoses during 1991. An in-depth examination of length of stay was undertaken for asthma discharges to determine whether CHMC could provide care for the most common cause of pediatric hospitalization for a length of stay similar to the community hospitals, and whether patients hospitalized at CHMC were different from those at the community hospitals for a number of sociodemographic and illness-related variables that could lengthen hospitalization.

Mean length of stay was similar at CHMC and the community hospitals for four diagnoses: two orthopedic, one surgical, and one common chronic medical condition. Median length of stay and interquartile ranges were similar at the two hospital groups for most of the diagnoses, implying that CHMC can compete with the local community hospitals when treating the "average" or "routine" hospitalized patient. Length of stay statistics for asthma were comparable at CHMC and the community hospitals, despite a larger percentage of publicly funded patients and a larger percentage of patients staying at least five days at CHMC. Thus, CHMC not only served as a safety net for poor children, but it also provided care for asthma patients requiring hospitalization for a length of stay comparable to the community hospitals.

--Author's foreword.