Avoidable hospitalization for pneumonia at city childrens hospital

Background. In order to evaluate the quality of primary care, avoidable hospitalization indicators or hospitalization indicators for ambulatory care sensitive conditions are used, among which is pneumonia.Objectives. To evaluate the status of pediatric hospitalization due to pneumonia and factors connected with primary care delivery to these patients.Methods. A cross-sectional study of hospital episodes and hospitalized children (aged 0-17 years) admitted and readmitted due to pneumonia to Lviv city childrens hospital in connection with the ways of inpatients referral and diagnosing at primary level was conducted. Information was obtained from medical record forms of children discharged from the hospital during 2008 year, with diagnosis of pneumonia.Results. During year 2008, there were 486 children with pneumonia discharged from the hospital, which accounted for 494 episodes of hospitalization with average length of stay (ALOS) of 11.7 days.The boys prevailed among the hospitalized patients (60.3%). Mean age of patients was 4.7. The number of hospitalized persons decreased while the patients age increased. LOS of boys was positively correlated with their age. There were registered 1.02 episodes per one hospitalized child. Readmissions had lower LOS (9.4 days), than primary episodes (11.8 days) (p = 0.049).Only in 30.8% of episodes, patients were referred to hospital by primary care physicians (PCP) of territorial health care institutions, where children live. In 20.9% of episodes, physicians of Lviv city childrens hospital referred children to their hospital. Every fourth child was hospitalized by request of parents, and one in five was delivered by ambulance, although the percentages of emergency episodes were low accordingly 36.4% of episodes hospitalized by parents request and 42.7% of episodes delivered by ambulance.Conclusions. The study has shown that LOS of children discharged from Lviv city childrens hospital due to pneumonia was higher than in other countries, but lower than LOS of other Ukrainian hospitals. Half of the patients were hospitalized bypassing the primary care level. For every fourth episodes at Lviv city childrens hospital, the referral diagnosis was different from the discharge diagnosis Pneumonia.Indications to emergency or non-emergency didnt influence the distribution of hospitalization episodes by the ways children were referred to the hospital, as well as misdiagnosing made by physicians at referral time.Further investigations should be carried out for identifying the proportion of avoidable pneumonia hospitalizations and