Variation in Care and Outcomes in Pediatric Acute Leukemia
Induction is the first phase of chemotherapy in pediatric acute leukemia. Mortality during induction within hospitals that contribute data to the Pediatric Health Information System (PHIS), an administrative database that includes 46 free-standing children’s hospitals, varies considerably. This variation suggests that there are center-level characteristics that could be contributing to the imbalance in induction mortality across institutions.
The goal of this study is to identify center-level characteristics and practice patterns that are associated with mortality during induction therapy for acute leukemia. Existing PHIS cohorts of patients with acute leukemia will be merged with data from the American Hospital Association (AHA) database that contains detailed information on hospitals. Timing of discharge from the hospital during induction and speed of chemotherapy initiation will be the practice patterns investigated in PHIS. The association with induction mortality of both the hospital characteristics found in AHA and the practice patterns found in PHIS will be explored. Finally, a pilot study will be developed to identify patient preferences regarding these hospital characteristics and practice patterns during induction. Patients and families that recently completed induction therapy will be interviewed to elicit their perceptions and feelings about interventions and outcomes related to their induction care. The results of this study have the potential to influence changes in the standards of induction care and to decrease deaths during induction for acute leukemia.