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Wang J, Xu DR, Zhang Y, Fu H, Wang S, Ju K, Chen C, Yang L, Jian W, Chen L, Liao X, Xiao Y, Wu R, Jakovljevic M, Chen Y, Pan J. Development of the China's list of ambulatory care sensitive conditions (ACSCs): a study protocol. Glob Health Res Policy 2024; 9:11. [PMID: 38504369 PMCID: PMC10949688 DOI: 10.1186/s41256-024-00350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The hospitalization rate of ambulatory care sensitive conditions (ACSCs) has been recognized as an essential indicator reflective of the overall performance of healthcare system. At present, ACSCs has been widely used in practice and research to evaluate health service quality and efficiency worldwide. The definition of ACSCs varies across countries due to different challenges posed on healthcare systems. However, China does not have its own list of ACSCs. The study aims to develop a list to meet health system monitoring, reporting and evaluation needs in China. METHODS To develop the list, we will combine the best methodological evidence available with real-world evidence, adopt a systematic and rigorous process and absorb multidisciplinary expertise. Specific steps include: (1) establishment of working groups; (2) generations of the initial list (review of already published lists, semi-structured interviews, calculations of hospitalization rate); (3) optimization of the list (evidence evaluation, Delphi consensus survey); and (4) approval of a final version of China's ACSCs list. Within each step of the process, we will calculate frequencies and proportions, use descriptive analysis to summarize and draw conclusions, discuss the results, draft a report, and refine the list. DISCUSSION Once completed, China's list of ACSCs can be used to comprehensively evaluate the current situation and performance of health services, identify flaws and deficiencies embedded in the healthcare system to provide evidence-based implications to inform decision-makings towards the optimization of China's healthcare system. The experiences might be broadly applicable and serve the purpose of being a prime example for nations with similar conditions.
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Affiliation(s)
- Jianjian Wang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Dong Roman Xu
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Yan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Sijiu Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Ke Ju
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Chu Chen
- School of Health Management, Fujian Medical University, Fujian, China
| | - Lian Yang
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Xiao
- China National Health Development Research Center, Beijing, China
| | - Ruixian Wu
- Center for Health Statistics and Information, National Health Commission, Beijing, China
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
- Institute of Comparative Economic Studies, Faculty of Economics, Hosei University, Tokyo, Japan
- Department of Global Health Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
- World Health Organization Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China.
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
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Parikh K, Hall M, Tieder JS, Dixon G, Ward MC, Hinds PS, Goyal MK, Rangel SJ, Flores G, Kaiser SV. Disparities in Racial, Ethnic, and Payer Groups for Pediatric Safety Events in US Hospitals. Pediatrics 2024; 153:e2023063714. [PMID: 38343330 DOI: 10.1542/peds.2023-063714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Health care disparities are pervasive, but little is known about disparities in pediatric safety. We analyzed a national sample of hospitalizations to identify disparities in safety events. METHODS In this population-based, retrospective cohort study of the 2019 Kids' Inpatient Database, independent variables were race, ethnicity, and payer. Outcomes were Agency for Healthcare Research and Quality pediatric safety indicators (PDIs). Risk-adjusted odds ratios were calculated using white and private payer reference groups. Differences by payer were evaluated by stratifying race and ethnicity. RESULTS Race and ethnicity of the 5 243 750 discharged patients were white, 46%; Hispanic, 19%; Black, 15%; missing, 8%; other race/multiracial, 7%, Asian American/Pacific Islander, 5%; and Native American, 1%. PDI rates (per 10 000 discharges) were 331.4 for neonatal blood stream infection, 267.5 for postoperative respiratory failure, 114.9 for postoperative sepsis, 29.5 for postoperative hemorrhage/hematoma, 5.6 for central-line blood stream infection, 3.5 for accidental puncture/laceration, and 0.7 for iatrogenic pneumothorax. Compared with white patients, Black and Hispanic patients had significantly greater odds in 5 of 7 PDIs; the largest disparities occurred in postoperative sepsis (adjusted odds ratio, 1.55 [1.38-1.73]) for Black patients and postoperative respiratory failure (adjusted odds ratio, 1.34 [1.21-1.49]) for Hispanic patients. Compared with privately insured patients, Medicaid-covered patients had significantly greater odds in 4 of 7 PDIs; the largest disparity occurred in postoperative sepsis (adjusted odds ratios, 1.45 [1.33-1.59]). Stratified analyses demonstrated persistent disparities by race and ethnicity, even among privately insured children. CONCLUSIONS Disparities in safety events were identified for Black and Hispanic children, indicating a need for targeted interventions to improve patient safety in the hospital.
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Affiliation(s)
- Kavita Parikh
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | | | - Gabrina Dixon
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Maranda C Ward
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Pamela S Hinds
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Monika K Goyal
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | - Glenn Flores
- Department of Pediatrics, University of Miami Miller School of Medicine, and Holtz Children's Hospital, Jackson Health System, Miami, Florida
| | - Sunitha V Kaiser
- University of California, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, San Francisco, California
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Gannon NP, Quanbeck ZA, Miller DJ. The influence of viral respiratory season on perioperative outcomes in patients undergoing spinal fusion for neuromuscular scoliosis. Spine Deform 2023; 11:407-414. [PMID: 36205854 DOI: 10.1007/s43390-022-00593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/18/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Respiratory complications are common following neuromuscular scoliosis (NMS) spinal fusion. Concern exists regarding the safety to perform complicated procedures in winter months when viral respiratory illness is common. The purpose of this study was to compare perioperative outcomes in children with NMS undergoing spinal fusion during peak (November-March) or non-peak (April-October) viral season. METHODS The Health Care and Utilization Project (HCUP) Kids' inpatient database (KID) from 2006 to 2012 was reviewed. Children 20 years or younger who underwent spinal fusion for NMS were included. Patients were grouped by date of surgery during peak or non-peak viral season. Continuous variables were compared using t tests and categorical variables were compared using the Rao-Scott Chi-square test. Weighted logistic regression models were performed. RESULTS This study identified 5082 records, including 1711 and 3371 patients who had surgery in peak and non-peak viral seasons, respectively. Patients who had spinal fusion during peak viral season were less likely to experience respiratory failure (p = 0.0008) and did not demonstrate an increased incidence of aspiration pneumonia (p = 0.26), respiratory complication (p = 0.43), or mortality (p = 0.68). Respiratory failure was associated with younger age (p = 0.0031), the presence of a tracheostomy (p < 0.0001), and the number of chronic conditions (p < 0.0001). Higher number of chronic medical conditions (mean of 5.0) was associated with an increased risk of in-hospital mortality (p < 0.0001), aspiration pneumonia (p = 0.0009), and respiratory failure (p < 0.0001). CONCLUSION Spinal fusion for NMS during peak viral season has a lower risk of respiratory failure without an increase in mortality or other complications compared to during non-peak viral season.
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Affiliation(s)
- Nicholas P Gannon
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Zachary A Quanbeck
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Daniel J Miller
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA. .,Gillette Children's Specialty Healthcare, 200 University Avenue East, St. Paul, MN, USA.
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Reardon KE, Foley CM, Melvin P, Agus MSD, Sanderson AL. Impact of a Clinical Documentation Integrity Program on Severity of Illness of Expired Patients. Hosp Pediatr 2021; 11:298-302. [PMID: 33541854 DOI: 10.1542/hpeds.2020-000851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND As payment models continue to move toward value-driven care, the quality of documentation has become more important than ever. Clinical Documentation Integrity (CDI) programs can aid in the documentation of diagnoses that are specific and consistent throughout the medical record, which leads to accurate code assignment, better understanding of patient complexity, and improved facility reimbursement. METHODS An interrupted time series analysis was conducted by using a segmented regression model to estimate the impact of our hospital's CDI program on perceived patient complexity using severity of illness stratification, observed to expected mortality ratio and case-mix index. Patients who died during the admission were chosen to limit our analysis to patients with the highest severity of illness. RESULTS A total of 206 patients who had died while inpatient at our 400 bed children's hospital were included. There was a 15.7% increase in patients who were final coded with the highest level of severity of illness after our CDI program launched compared with those patients admitted before program inception. The hospital case-mix index for inpatient cases increased 25% from 2011 to 2017. There was a 44% decrease in the observed to expected mortality ratio. DISCUSSION A CDI program can have a significant impact, as evidenced by our ability to show complexity gains on some of the sickest patients by supporting documentation of precise, accurate diagnoses. In turn, this may allow for better understanding of the complexity of our patient population and support appropriate reimbursement and payer contract negotiations.
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Affiliation(s)
- Katelyn E Reardon
- Department of Patient Care Services, Boston Children's Hospital, Boston, Massachusetts
| | - Corinna M Foley
- Department of Patient Care Services, Boston Children's Hospital, Boston, Massachusetts
| | - Patrice Melvin
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, Massachusetts
| | - Michael S D Agus
- Divisions of Medical Critical Care and Endocrinology, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts; and
| | - Amy L Sanderson
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts;
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Zucco R, Pileggi C, Vancheri M, Papadopoli R, Nobile CGA, Pavia M. Preventable pediatric hospitalizations and access to primary health care in Italy. PLoS One 2019; 14:e0221852. [PMID: 31644581 PMCID: PMC6808327 DOI: 10.1371/journal.pone.0221852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/18/2019] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to quantify the burden of avoidable pediatric hospital admissions for Ambulatory care-sensitive conditions (ACSC) and to identify factors related to these preventable hospitalizations. The study was conducted by retrospectively reviewing all medical records of children admitted in a non-teaching 474-bed acute care hospital located in Catanzaro (Italy) for an avoidable hospitalization diagnosis. Two control clinical records involving children hospitalized for clinical conditions not classified as ACSC were randomly selected for each clinical record that included an ACSC. Among the 4293 pediatric hospitalizations, 451 (10.5%) were judged to be preventable. Of these, the most frequent discharge diagnoses were: dehydration (29.7%), pneumonia (17.7%), seizures (15.7%) and chronic obstructive pulmonary disease (12.9%).Children admitted for a preventable hospitalization were more likely to be females, to be younger, to be residents in the same province as the hospital and less likely to have had at least one Community-Based Pediatrician (CBP) access in the previous year and to have used the district health service. The burden of pediatric preventable hospitalizations found in this study is quite high, and the results show that there is still work that lies ahead on the way to improve interaction between hospital and community-based services.
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Affiliation(s)
- Rossella Zucco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Martina Vancheri
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Rosa Papadopoli
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | | | - Maria Pavia
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
- * E-mail:
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Pediatric Training and Experience Requirements—Development of UNOS Bylaws. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lind J, Schollin Ask L, Juarez S, Hjern A. Hospital care for viral gastroenteritis in socio-economic and geographical context in Sweden 2006-2013. Acta Paediatr 2018; 107:2011-2018. [PMID: 29863748 DOI: 10.1111/apa.14429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/16/2018] [Accepted: 05/29/2018] [Indexed: 01/09/2023]
Abstract
AIM We investigated socio-economic and geographical determinants of hospital care for viral gastroenteritis in young children. METHOD This is a register-based study in a national birth cohort of 752 078 children 0-5 years of age in Sweden during 2006-2012. Hazard ratios (HR) of time to first admission and first episode of outpatient emergency department (ED) care with a diagnosis of viral gastroenteritis were estimated with Cox regression. RESULTS The adjusted HRs for hospital admission with a diagnosis of viral gastroenteritis were increased when the mother was below 25 years at the birth of the child, 1.30 (95% CI: 1.24-1.35), had a short (<=9 years) education, 1.18 (95% CI: 1.12-1.23), a psychiatric disorder, 1.34 (95% CI: 1.30-1.39), and/or when parents were born outside Europe, 1.23 (95% CI: 1.18-1.29). In contrast, the disposable income of the family was only marginally associated with such hospital admissions. The pattern of HRs for outpatient ED hospital care was similar. Hospital care incidences for viral gastroenteritis differed considerably between Swedish counties. CONCLUSION Parental indicators associated with a lower level of health literacy increase the risk for hospital care due to gastroenteritis in young children. Information about oral rehydration should be provided in ways that are accessible to these parents.
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Affiliation(s)
| | - Lina Schollin Ask
- Sachs’ Children and Youth Hospital; South General Hospital; Stockholm Sweden
- Department of Medicine; Clinical Epidemiology Unit; Karolinska Institutet; Stockholm Sweden
| | - Sol Juarez
- CHESS; Centre for Health Equity Studies; Stockholm University and Karolinska Institutet; Stockholm Sweden
| | - Anders Hjern
- Sachs’ Children and Youth Hospital; South General Hospital; Stockholm Sweden
- Department of Medicine; Clinical Epidemiology Unit; Karolinska Institutet; Stockholm Sweden
- CHESS; Centre for Health Equity Studies; Stockholm University and Karolinska Institutet; Stockholm Sweden
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8
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Nelson KE, Feinstein JA, Gerhardt CA, Rosenberg AR, Widger K, Faerber JA, Feudtner C. Emerging Methodologies in Pediatric Palliative Care Research: Six Case Studies. CHILDREN-BASEL 2018; 5:children5030032. [PMID: 29495384 PMCID: PMC5867491 DOI: 10.3390/children5030032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 12/17/2022]
Abstract
Given the broad focus of pediatric palliative care (PPC) on the physical, emotional, and spiritual needs of children with potentially life-limiting illnesses and their families, PPC research requires creative methodological approaches. This manuscript, written by experienced PPC researchers, describes issues encountered in our own areas of research and the novel methods we have identified to target them. Specifically, we discuss potential approaches to: assessing symptoms among nonverbal children, evaluating medical interventions, identifying and treating problems related to polypharmacy, addressing missing data in longitudinal studies, evaluating longer-term efficacy of PPC interventions, and monitoring for inequities in PPC service delivery.
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Affiliation(s)
- Katherine E Nelson
- Pediatric Advanced Care Team, Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
| | - James A Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Children's Hospital Colorado, Aurora, CO 80045, USA.
- Division of General Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH 43210, USA.
| | - Abby R Rosenberg
- Department of Pediatrics, University of Washington School of Medicine; Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA 98101, USA.
| | - Kimberley Widger
- Pediatric Advanced Care Team, Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada.
| | - Jennifer A Faerber
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Sarda S, Short HL, Hockenberry JM, McCarthy I, Raval MV. Regional variation in rates of pediatric perforated appendicitis. J Pediatr Surg 2017; 52:1488-1491. [PMID: 28259382 DOI: 10.1016/j.jpedsurg.2017.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND While trends in perforated appendicitis (PA) rates have been studied, regional variability in pediatric admissions for PA remains unknown. METHODS A retrospective, cross-sectional analysis of the 2006-2012 Kids' Inpatient Database was conducted to examine variation in PA admission rates by region of the United States and insurance status. PA rates were calculated and reported as per 1000 admissions in accordance with national quality measure specifications. RESULTS National PA rates per 1000 admissions for 2006, 2009, and 2012 were 313.9, 279.2, and 309.1, respectively. Similarly, all regions demonstrated a statistically significant decrease in PA rates between 2006 and 2009 (p<0.001), where the increase in rates between 2009 and 2012 was only statistically significant in the Midwest [Odds Ratio (OR) 1.07; 95% Confidence Interval (95%CI) 1.03-1.12] and West (OR 1.10; 95% CI 1.07-1.14). The Northeast consistently experienced the lowest PA rates. The odds of PA were highest among uninsured patients (OR 1.35; 95% CI 1.31-1.29). The South had the highest proportion of uninsured children, and these patients had the highest odds of perforation (OR 1.57; 95% CI 1.21-2.02). CONCLUSIONS For children with appendicitis, geographic region and insurance status appear to be associated with perforation upon presentation. Understanding regional variation in pediatric PA rates may inform health policymakers in the constantly evolving insurance coverage landscape. LEVELS OF EVIDENCE RATING Level III Treatment Study - Retrospective comparative study of appendicitis presentation in children by region of the country.
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Affiliation(s)
- Samir Sarda
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Heather L Short
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Jason M Hockenberry
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ian McCarthy
- Deparment of Economics, Emory University, Atlanta, GA, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
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Medford-Davis LN, Shah R, Kennedy D, Becker E. Factors Associated With Potentially Preventable Pediatric Admissions Vary by Diagnosis: Findings From a Large State. Hosp Pediatr 2016; 6:595-606. [PMID: 27634770 DOI: 10.1542/hpeds.2016-0038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objective of this study was to determine characteristics associated with potentially preventable pediatric admissions as defined by the Agency for Healthcare Research and Quality. METHODS The Texas Inpatient Public Use Data File, an administrative database of hospital admissions, identified 747 040 pediatric admissions ages 0 to 17 years to acute care facilities between 2005 and 2008. Potentially preventable admissions included 5 diagnoses: asthma, perforated appendicitis, diabetes, gastroenteritis, and urinary tract infection. A hierarchical multivariable logistic regression model clustered by admitting hospital and adjusted for admission date estimated the patient and hospital factors associated with potentially preventable admission. RESULTS An average of 71 444 hospital days per year and 14.1% (N = 105 055) of all admissions were potentially preventable, generating $304 million in hospital charges per year in 1 state. Younger age (odds ratio [OR]: 2.88 [95% confidence interval (CI): 2.80-2.96]), black race (OR: 1.48 [95% CI: 1.45-1.52]) or Hispanic ethnicity (OR: 1.06 [95% CI: 1.04-1.08]), lower income (OR: 1.11 [95% CI: 1.02-1.20]), comorbid substance abuse disorder (OR: 2.03 [95% CI: 1.75-2.34]), and admission on a weekend (OR: 1.05 [95% CI: 1.03-1.06]) or to a critical access hospital (OR: 1.61 [95% CI: 1.20-2.14]) were high-risk factors for potentially preventable admission, whereas Native American race (OR: 0.91 [95% CI: 0.85-0.98]), government insurance (OR: 0.83 [95% CI: 0.89-0.96]) or no insurance (OR: 0.93 [95% CI: 0.89-0.96]), and living in a rural county (OR: 0.70 [95% CI: 0.68-0.73]) were associated factors. However, most factors varied from high to low odds depending on which of the 5 potentially preventable diagnoses was examined. CONCLUSIONS Potentially preventable admissions represent a high burden of time and costs for the pediatric population, but strategies to reduce them should be tailored to each diagnosis because the associated factors are not uniform across all potentially preventable admissions.
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Affiliation(s)
| | - Rohan Shah
- Baylor College of Medicine, Houston, Texas; and
| | | | - Emilie Becker
- Texas Health and Human Services Commission, Texas Medicaid and CHIP Program, Austin, Texas
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11
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Jenkins KJ, Koch Kupiec J, Owens PL, Romano PS, Geppert JJ, Gauvreau K. Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS-1) Methodology. J Am Heart Assoc 2016; 5:e003028. [PMID: 27207997 PMCID: PMC4889177 DOI: 10.1161/jaha.115.003028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS-1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies. METHODS AND RESULTS Parameters that were identical between the 2 methods were retained. AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases (SID) 2008 were used to select optimal parameters where differences existed, with a goal to maximize model performance and face validity. Inclusion criteria were not changed and included all discharges for patients <18 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for congenital heart surgery or nonspecific heart surgery combined with congenital heart disease diagnosis codes. The final model includes procedure risk group, age (0-28 days, 29-90 days, 91-364 days, 1-17 years), low birth weight (500-2499 g), other congenital anomalies (Clinical Classifications Software 217, except for 758.xx), multiple procedures, and transfer-in status. Among 17 945 eligible cases in the SID 2008, the c statistic for model performance was 0.82. In the SID 2013 validation data set, the c statistic was 0.82. Risk-adjusted mortality rates by center ranged from 0.9% to 4.1% (5th-95th percentile). CONCLUSIONS Congenital heart surgery programs can now obtain national benchmarking reports by applying AHRQ Quality Indicator software to hospital administrative data, based on the harmonized RACHS-1 method, with high discrimination and face validity.
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Affiliation(s)
| | | | - Pamela L Owens
- Agency for Healthcare Research and Quality, Rockville, MD
| | - Patrick S Romano
- University of California Davis School of Medicine, Sacramento, CA
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Abstract
This article describes important aspects of health-care quality, quality improvement (QI), patient safety (PS), and approaches to research on QI/PS efforts. Common terminology to facilitate an understanding of QI and PS research is reviewed. Models for understanding system and process performance are discussed. Introductory considerations to QI data and QI research analytical considerations are provided.
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Affiliation(s)
- Matthew F Niedner
- Pediatric Intensive Care Unit, Division of Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital, University of Michigan Medical Center, F-6894 Mott #0243, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0243, USA.
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13
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Abstract
Background Child health care is an important part of the UK general practice workload; in 2009 children aged <15 years accounted for 10.9% of consultations. However, only 1.2% of the UK’s Quality and Outcomes Framework pay-for-performance incentive points relate specifically to children. Aim To improve the quality of care provided for children and adolescents by defining a set of quality indicators that reflect evidence-based national guidelines and are feasible to audit using routine computerised clinical records. Design and setting Multi-step consensus methodology in UK general practice. Method Four-step development process: selection of priority issues (applying nominal group methodology), systematic review of National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) clinical guidelines, translation of guideline recommendations into quality indicators, and assessment of their validity and implementation feasibility (applying consensus methodology used in selecting QOF indicators). Results Of the 296 national guidelines published, 48 were potentially relevant to children in primary care, but only 123 of 1863 recommendations (6.6%) met selection criteria for translation into 56 potential quality indicators. A further 13 potential indicators were articulated after review of existing quality indicators and standards. Assessment of the validity and feasibility of implementation of these 69 candidate indicators by a clinical expert group identified 35 with median scores 8 on a 9-point Likert scale. However, only seven of the 35 achieved a GRADE rating >1 (were based on more than expert opinion). Conclusion Producing valid primary care quality indicators for children is feasible but difficult. These indicators require piloting before wide adoption but have the potential to raise the standard of primary care for all children.
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Rinke ML, Bundy DG, Abdullah F, Colantuoni E, Zhang Y, Miller MR. State-Mandated Hospital Infection Reporting Is Not Associated With Decreased Pediatric Health Care-Associated Infections. J Patient Saf 2015; 11:123-34. [PMID: 24681422 PMCID: PMC4177525 DOI: 10.1097/pts.0000000000000056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES State governments increasingly mandate public reporting of central line-associated blood stream infections (CLABSIs). This study tests if hospitals located in states with state-mandated, facility-identified, pediatric-specific public CLABSI reporting have lower rates of CLABSIs as defined by the Agency for Healthcare Research and Quality's Pediatric Quality Indicator 12 (PDI12). METHODS Utilizing the Kids' Inpatient Databases from 2000 to 2009, we compared changes in PDI12 rates across three groups of states: states with public CLABSI reporting begun by 2006, states with public reporting begun by 2009 and never-reporting states. In the baseline period (2000-2003), no states mandated public CLABSI reporting. A multivariable, hospital-level random intercept, logistic regression was performed comparing changes in PDI12 rates in states with public reporting to changes in PDI12 rates in never-reporting states. RESULTS 4,705,857 discharge records were eligible for PDI12. PDI12 rates significantly decreased in all reporting groups, comparing baseline to the post-public reporting period (2009): Never Reporters 88% decrease (95% CI, 86%-89%), Reporting Begun by 2006 90% decrease (95% CI, 83%-94%), and Reporting Begun by 2009 74% decrease (95% CI, 72%-76%). The Never Reporting Group had comparable decreases in PDI12 rates to the Reporting Begun by 2006 group (P = 0.4) and significantly larger decreases in PDI12 rates compared to the Reporting Begun by 2009 group (P < 0.001), despite having no states with public reporting. CONCLUSIONS Public CLABSI reporting alone appears to be insufficient to affect administrative data-based measures of pediatric CLABSI rates or children may be inadequately targeted in current public reporting efforts.
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Affiliation(s)
- Michael L. Rinke
- Department of Pediatrics, The Children’s Hospital at Montefiore, Bronx, NY
| | - David G. Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Fizan Abdullah
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Yiyi Zhang
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marlene R. Miller
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Children’s Hospital Association, Alexandria, Virginia
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Bushelle-Edghill JH, Laditka SB, Laditka JN, Brunner Huber LR. Assessing a Public Health Intervention for Children in Barbados, 2003-2008. Prev Chronic Dis 2015; 12:E137. [PMID: 26312382 PMCID: PMC4556103 DOI: 10.5888/pcd12.150120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction In 2003, Barbados, a developing country with universal health care, launched the Barbados Strategic Plan for Health, a national intervention to promote public health. Teachers, health educators, and clinicians worked to improve children’s health, with particular focus on asthma and diabetes. We studied this intervention by using data on preventable hospitalization, an indicator that assesses both the overall effectiveness of public health and access to primary health care. The purpose of this study was to assess the Barbados Strategic Plan for Health by measuring rates of preventable hospitalization among children. Few researchers have studied these hospitalizations for children, and only 1 study has done so in a developing country. Methods We calculated annual (2003–2008) population-based rates of preventable hospitalizations from birth through age 19, both summary and disease-specific, for the 5 conditions that define the indicator for children: asthma, diabetes, gastroenteritis, urinary tract infection, and perforated appendix. Results Across the 6 years, the population rates of preventable hospitalizations increased 115.4% for boys and 67.2% for girls (both P < .001). Asthma accounted for much of the increase. Regression analysis indicated that the average annual increase in asthma hospitalization for boys was 0.45 per 1,000, an average annual increase of 20.6% of the baseline rate. These results suggest generally increasing rates of hospitalization for asthma for boys. There was no evidence of a corresponding rate trend for girls. Conclusion Results suggest an opportunity to improve public health education and access to primary health care. Public health professionals in developing countries can use the approaches of this study to evaluate initiatives to improve child health.
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Affiliation(s)
| | - Sarah B Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - James N Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Larissa R Brunner Huber
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
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Berry JG, Zaslavsky AM, Toomey SL, Chien AT, Jang J, Bryant MC, Klein DJ, Kaplan WJ, Schuster MA. Recognizing Differences in Hospital Quality Performance for Pediatric Inpatient Care. Pediatrics 2015; 136:251-62. [PMID: 26169435 PMCID: PMC4516938 DOI: 10.1542/peds.2014-3131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hospital quality-of-care measures are publicly reported to inform consumer choice and stimulate quality improvement. The number of hospitals and states with enough pediatric hospital discharges to detect worse-than-average inpatient care remains unknown. METHODS This study was a retrospective analysis of hospital discharges for children aged 0 to 17 years from 3974 hospitals in 44 states in the 2009 Kids' Inpatient Database. For 11 measures of all-condition or condition-specific quality, we assessed the number of hospitals and states that met a "power standard" of 80% power for a 5% level significance test to detect when care is 20% worse than average over a 3-year period. For this assessment, we approximated volume as 3 times actual 2009 admission volumes. RESULTS For all-condition quality, 1380 hospitals (87% of all pediatric discharges) and all states met the power standard for the family experience-of-care measure; 1958 hospitals (95% of discharges) and all states met the standard for adverse drug events. For condition-specific quality measures of asthma, birth, and mental health, 203 to 482 hospitals (52%-90% of condition-specific discharges) met the power standard and 40 to 44 states met the standard. One hospital and 16 states met the standard for sickle cell disease. No hospital and ≤27 states met the standard for the remaining measures studied (appendectomy, cerebrospinal fluid shunt surgery, gastroenteritis, heart surgery, and seizure). CONCLUSIONS Most children are admitted to hospitals in which all-condition measures of quality have adequate power to show modest differences in performance from average, but most condition-specific measures do not. Policies regarding incentives for pediatric inpatient quality should take these findings into account.
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Affiliation(s)
- Jay G. Berry
- Division of General Pediatrics, and,Division of General Pediatrics, Department of Medicine, and
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Sara L. Toomey
- Division of General Pediatrics, and,Division of General Pediatrics, Department of Medicine, and
| | - Alyna T. Chien
- Division of General Pediatrics, and,Division of General Pediatrics, Department of Medicine, and
| | - Jisun Jang
- Clinical Research Center, Boston Children’s Hospital, Boston, Massachusetts; and
| | | | | | | | - Mark A. Schuster
- Division of General Pediatrics, and,Division of General Pediatrics, Department of Medicine, and
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Lantz PM, Rubin N, Mauery DR. Hospital leadership perspectives on the contributions of Ronald McDonald Houses. J Health Organ Manag 2015; 29:381-92. [DOI: 10.1108/jhom-09-2013-0194] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to describe an international survey of hospital executives and administrators’ perspectives on the contributions of their affiliation with a Ronald McDonald House (RMH) as an example of accommodation in family-centered care to the hospital’s mission, operations and patient experience.
Design/methodology/approach
– RMHs worldwide provided the names and e-mail addresses of the people holding key leadership positions in their main hospital partner, who in turn were invited to complete an internet-based survey (530 participants; response rate of 54.5 percent).
Findings
– Hospital leaders reported very positive opinions about the contributions of their RMHs affiliation to their ability to serve seriously ill children and their families. This included such important outcomes as increasing family integrity and family participation in care decisions; and decreasing psychosocial stress and hospital social work resource burdens associated with lodging, food, transportation and sibling support. Hospital chief executive offices (CEOs) and medical directors reported very strong and positive opinions regarding the value-added of their RMHs affiliation in many areas, including enhanced marketing of hospital specialty services and reduced length of stay.
Research limitations/implications
– Survey response bias is a limitation, although the results are still useful in terms of identifying multiple ways in which RMHs are perceived as contributing to hospitals’ operations and provision of family-centered care.
Practical implications
– Overall, the results suggest that, internationally, hospital leaders believe that RMHs play a key and valued role in their provision of family-centered care to seriously ill children and their families.
Social implications
– Family accommodation is more than the simple provision of lodging and plays an integral role how hospitals approach family-centered care.
Originality/value
– This international study contributes to the general literature on the role of family accommodation in hospitals’ provision of family-centered care and the specific and very sparse literature on RMHs in particular.
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Kelleher KJ, Cooper J, Deans K, Carr P, Brilli RJ, Allen S, Gardner W. Cost saving and quality of care in a pediatric accountable care organization. Pediatrics 2015; 135:e582-9. [PMID: 25667248 DOI: 10.1542/peds.2014-2725] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Accountable care organizations (ACOs) are responsible for costs and quality across a defined population. To succeed, the ACO must improve value by reducing costs while either maintaining or improving the quality of care. We examined changes from 2008 through 2013 in the cost and quality of care for Partners for Kids (PFK), a pediatric ACO serving an Ohio Medicaid population. METHODS We measured the historical cost of care for PFK and gathered comparison statewide Ohio Medicaid fee-for-service (FFS) and managed care (MC) cost histories. Changes in quality of care measures were assessed by using 15 Agency for Healthcare Research and Quality Pediatric Quality Indicators and 4 indicators targeted by PFK. RESULTS PFK per-member-per-month costs were lower in 2008 than either FFS or MC (P < .001) costs and grew at a rate of $2.40 per year compared with FFS increases of $16.15 per year (P < .001) and MC increases of $6.47 per year (P < .121) with ∼3.5 million member-months each year. The quality of care of children in PFK improved significantly (P < .05) in 2011-2013 versus 2008-2010 on 5 quality measures (including 2 composite measures) and declined significantly on 3 measures. Other measures did not change or were rare events with no measureable change. CONCLUSIONS PFK reduced the growth in costs compared with FFS Medicaid and averages less than MC Medicaid. This slowing in cost growth was achieved without diminishing the overall quality or outcomes of care. PFK thus improved the value of care for Medicaid children.
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Affiliation(s)
- Kelly J Kelleher
- Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio;
| | - Jennifer Cooper
- Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Katherine Deans
- Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Pam Carr
- Partners for Kids, Columbus, Ohio; and
| | - Richard J Brilli
- Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Steven Allen
- Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - William Gardner
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Lenzi J, Luciano L, McDonald KM, Rosa S, Damiani G, Corsello G, Fantini MP. Empirical examination of the indicator 'pediatric gastroenteritis hospitalization rate' based on administrative hospital data in Italy. Ital J Pediatr 2014; 40:14. [PMID: 24512747 PMCID: PMC3923239 DOI: 10.1186/1824-7288-40-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/06/2014] [Indexed: 11/24/2022] Open
Abstract
Background Awareness of the importance of strengthening investments in child health and monitoring the quality of services in the pediatric field is increasing. The Pediatric Quality Indicators developed by the US Agency for Healthcare Research and Quality (AHRQ), use hospital administrative data to identify admissions that could be avoided through high-quality outpatient care. Building on this approach, the purpose of this study is to perform an empirical examination of the ‘pediatric gastroenteritis admission rate’ indicator in Italy, under the assumption that lower admission rates are associated with better management at the primary care level and with overall better quality of care for children. Methods Following the AHRQ process for evaluating quality indicators, we examined age exclusion/inclusion criteria, selection of diagnostic codes, hospitalization type, and methodological issues for the ‘pediatric gastroenteritis admission rate’. The regional variability of hospitalizations was analyzed for Italian children aged 0–17 years discharged between January 1, 2009 and December 31, 2011. We considered hospitalizations for the following diagnoses: non-bacterial gastroenteritis, bacterial gastroenteritis and dehydration (along with a secondary diagnosis of gastroenteritis). The data source was the hospital discharge records database. All rates were stratified by age. Results In the study period, there were 61,130 pediatric hospitalizations for non-bacterial gastroenteritis, 5,940 for bacterial gastroenteritis, and 38,820 for dehydration. In <1-year group, the relative risk of hospitalization for non-bacterial gastroenteritis was 24 times higher than in adolescents, then it dropped to 14.5 in 1- to 4-year-olds and to 3.2 in 5- to 9-year-olds. At the national level, the percentage of admissions for bacterial gastroenteritis was small compared with non-bacterial, while including admissions for dehydration revealed a significant variability in diagnostic coding among regions that affected the regional performance of the indicator. Conclusions For broadest application, we propose a ‘pediatric gastroenteritis admission rate’ that consists of including bacterial gastroenteritis and dehydration diagnoses in the numerator, as well as infants aged <3 months. We also suggest adjusting for age and including day hospital admissions. Future evaluation by a clinical panel at the national level might be helpful to determine appropriate application for such measures, and make recommendations to policy makers.
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Affiliation(s)
| | | | | | | | | | | | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
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Luciano L, Lenzi J, McDonald KM, Rosa S, Damiani G, Corsello G, Fantini MP. Empirical validation of the "Pediatric Asthma Hospitalization Rate" indicator. Ital J Pediatr 2014; 40:7. [PMID: 24447802 PMCID: PMC3899920 DOI: 10.1186/1824-7288-40-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/18/2014] [Indexed: 11/24/2022] Open
Abstract
Background Quality assessment in pediatric care has recently gained momentum. Although many of the approaches to indicator development are similar regardless of the population of interest, few nationwide sets of indicators specifically designed for assessment of primary care of children exist. We performed an empirical analysis of the validity of “Pediatric Asthma Hospitalization Rate” indicator under the assumption that lower admission rates are associated with better performance of primary health care. Methods The validity of “Pediatric Asthma Hospitalization Rate” indicator proposed by the Agency for Healthcare Research and Quality in the Italian context was investigated with a focus on selection of diagnostic codes, hospitalization type, and risk adjustment. Seasonality and regional variability of hospitalization rates for asthma were analyzed for Italian children aged 2–17 years discharged between January 1, 2009, and December 31, 2011 using the hospital discharge records database. Specific rates were computed for age classes: 2–4, 5–9, 10–14, 15–17 years. Results In the years 2009–2011 the number of pediatric hospitalizations for asthma was 14,389 (average annual rate: 0.52 per 1,000) with a large variability across regions. In children aged 2–4 years, the risk of hospitalization for asthma was 14 times higher than in adolescents, then it dropped to 4 in 5- to 9-year-olds and to 1.1 in 10- to 14-year-olds. The inclusion of diagnoses of bronchitis revealed that asthma and bronchitis are equally represented as causes of hospital admissions and have a similar seasonality in preschool children, while older age groups experience hospital admissions mainly in spring and fall, this pattern being consistent with a diagnosis of atopic asthma. Rates of day hospital admissions for asthma were up to 5 times higher than the national average in Liguria and some Southern regions, and close to zero in some Northern regions. Conclusions The patterns of hospitalization for pediatric asthma in Italy showed that at least two different indicators are needed to measure accurately the quality of care provided to children. The candidate indicators should also include day hospital admissions to better assess accessibility. Future evaluation by a structured clinical panel review at the national level might be helpful to refine indicator definitions and risk groupings, to determine appropriate application for such measures, and to make recommendations to policy makers.
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Affiliation(s)
| | | | | | | | | | | | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, Bologna 40126, Italy.
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Wilson S, Bremner AP, Hauck Y, Finn J. Evaluation of paediatric nursing-sensitive outcomes in an Australian population using linked administrative hospital data. BMC Health Serv Res 2013; 13:396. [PMID: 24103062 PMCID: PMC3852600 DOI: 10.1186/1472-6963-13-396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 09/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research into nursing-sensitive outcomes using administrative health data has focussed on hospitalised adults. However, we developed algorithms for the identification of 13 paediatric nursing-sensitive outcomes, which we seek to examine for clinical utility. The aims were to determine the rates of paediatric nursing-sensitive outcomes in a Western Australian hospital and ascertain sociodemographic and clinical characteristics associated with a greater risk of developing nursing-sensitive outcomes in hospitalised children. METHOD A retrospective cohort study used linked administrative data of all Western Australian children ≤18 years admitted to the only tertiary paediatric hospital in Perth between 1999 and 2009. Rates per 1,000 hospital separations and per 10,000 patient days were calculated for the following nursing-sensitive outcomes: lower respiratory tract infection (LRTI), gastrointestinal (GI) infection, pneumonia, sepsis, arrest/shock/respiratory failure, central nervous system complication, central venous line infection, infectious disease, pressure ulcer, failure to rescue, surgical wound infection, physiologic/metabolic derangement, and postoperative cardiopulmonary complications. Poisson multiple regression models were fitted to estimate rate ratios (RR) and 95% confidence intervals (CI) for suspected risk factors. RESULTS Linked records of 129,719 hospital separations were analysed. Rates ranged from 0.5/1,000 for pressure ulcer to 14.0/1,000 hospital separations for GI infections. Age was significantly associated with the risk of a nursing-sensitive outcome: compared with adolescents, toddlers had greater risk of GI infection (RR 9.89; 95% CI 6.24, 15.69); infants had 7.74 times greater risk of LRTI (95% CI 5.11, 11.75), while neonates had lower risks for sepsis (RR 0.26; 95% CI 0.08, 0.90) and physiologic/metabolic derangement (RR 0.12; 95% CI 0.04, 0.35). The risk of surgical wound infection was 7.78 times greater (95% CI 5.10, 11.86) for emergency admissions than elective admissions. CONCLUSIONS Seven of the 13 defined nursing-sensitive outcomes occurred with sufficient frequency (>100 events over the 10 year study period) to be potentially useful for monitoring the quality of nursing care. These nursing-sensitive outcomes are: LRTI, GI infection, pneumonia, surgical wound infection, physiologic/metabolic derangement, sepsis and postoperative cardiopulmonary complications. When used for quality improvement or to benchmark with other agencies, data need to be adjusted for, or stratified by age and admission type, to ensure equitable comparisons.
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Affiliation(s)
- Sally Wilson
- School of Population Health, The University of Western Australia, 35 Stirling Hwy, Perth 6009, Western Australia
- School of Nursing and Midwifery, Curtin University, GPO Box U1987, Perth 6845, Western Australia
| | - Alexandra P Bremner
- School of Population Health, The University of Western Australia, 35 Stirling Hwy, Perth 6009, Western Australia
| | - Yvonne Hauck
- School of Nursing and Midwifery, Curtin University, GPO Box U1987, Perth 6845, Western Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth 6845, Western Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia
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Paciorkowski N, Pruitt C, Lashly D, Hrach C, Harrison E, Srinivasan M, Turmelle M, Carlson D. Development of performance tracking for a pediatric hospitalist division. Hosp Pediatr 2013; 3:118-128. [PMID: 24340412 DOI: 10.1542/hpeds.2012-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Our goal was to develop a comprehensive performance tracking process for a large pediatric hospitalist division. We aimed to use established dimensions and theory of health care quality to identify measures relevant to common inpatient diagnoses, reflective of current standards of clinical care, and applicable to individual physician performance. We also sought to implement a reproducible data collection strategy that minimizes manual data collection and measurement bias. METHODS Washington University Division of Pediatric Hospital Medicine provides clinical care in 17 units within 3 different hospitals. Hospitalist services were grouped into 5 areas, and a task group was created of divisional leaders representing clinical services. The group was educated on the health care quality theory and tasked to search clinical practice standards and quality resources. The groups proposed a broad spectrum of performance questions that were screened for electronic data availability and modified into measurable formulas. RESULTS Eighty-seven performance questions were identified and analyzed for their alignment with known clinical guidelines and value in measuring performance. Questions were distributed across quality domains, with most addressing safety. They reflected structure, outcome, and, most commonly, process. Forty-seven questions were disease specific, and 79 questions reflected individual physician performance; 52 questions had electronically available data. CONCLUSIONS We describe a systematic approach to the development of performance indicators for a pediatric hospitalist division that can be used to measure performance on a division and physician level. We outline steps to develop a broad-spectrum quality tracking process to standardize clinical care and build invaluable resources for quality improvement research.
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Affiliation(s)
- Natalia Paciorkowski
- Washington University, St Louis School of Medicine, Department of Pediatrics, Division of Hospitalist Medicine, St Louis, Missouri 63110, USA
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Quinn C, Bonuck K. Identifying breastfeeding-sensitive conditions by expert consensus. J Hum Lact 2012; 28:535-42. [PMID: 22956743 PMCID: PMC4684639 DOI: 10.1177/0890334412456603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Infant feeding-related health outcomes need to be consistently defined prior to inclusion in health services research. OBJECTIVE To categorize conditions common in infants under 12 months old by their association with breastfeeding for use as outcome measures in a randomized, controlled trial of breastfeeding promotion. METHODS A modified Delphi consensus method synthesized opinions of 13 physician experts on breastfeeding's association with ICD-9 infant diagnosis codes derived from literature review and medical center experience. A pilot round and 2 subsequent Delphi rounds were used. For the first round, consensus was achieved when more than 80% of experts agreed on a classification for a particular condition, with a predetermined level of certainty based on a 7-point Likert scale. For the second round, consensus was achieved when a majority of experts agreed on the classification from Round 1. RESULTS An initial 68 diagnosis codes were identified for evaluation by the expert panel. After a pilot round, the codes were refined and condensed, which resulted in 38 diagnoses for categorization into 1 of 3 categories: (1) breastfeeding protects against the condition; (2) breastfeeding may cause or worsen the condition; and (3) breastfeeding is unrelated to the condition. At the conclusion of the process, consensus was achieved on the classification of 31 conditions, and 7 conditions remained unclassified because of a lack of consensus. CONCLUSIONS This study provides a list of conditions common in infants under 12 months of age classified based on relationship to infant feeding method and validated by expert consensus. These conditions, based on readily available insurance claims data, contribute to the standardization of outcome measures used for health services research related to breastfeeding promotion.
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Affiliation(s)
- Celia Quinn
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Reoperation Rates and Administrative Databases. Med Care 2012. [DOI: 10.1097/mlr.0b013e31826b752a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wilson S, Bremner AP, Hauck Y, Finn J. Identifying paediatric nursing-sensitive outcomes in linked administrative health data. BMC Health Serv Res 2012; 12:209. [PMID: 22818363 PMCID: PMC3467158 DOI: 10.1186/1472-6963-12-209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 07/04/2012] [Indexed: 11/17/2022] Open
Abstract
Background There is increasing interest in the contribution of the quality of nursing care to patient outcomes. Due to different casemix and risk profiles, algorithms for administrative health data that identify nursing-sensitive outcomes in adult hospitalised patients may not be applicable to paediatric patients. The study purpose was to test adult algorithms in a paediatric hospital population and make amendments to increase the accuracy of identification of hospital acquired events. The study also aimed to determine whether the use of linked hospital records improved the likelihood of correctly identifying patient outcomes as nursing sensitive rather than being related to their pre-morbid conditions. Methods Using algorithms developed by Needleman et al. (2001), proportions and rates of records that identified nursing-sensitive outcomes for pressure ulcers, pneumonia and surgical wound infections were determined from administrative hospitalisation data for all paediatric patients discharged from a tertiary paediatric hospital in Western Australia between July 1999 and June 2009. The effects of changes to inclusion and exclusion criteria for each algorithm on the calculated proportion or rate in the paediatric population were explored. Linked records were used to identify comorbid conditions that increased nursing-sensitive outcome risk. Rates were calculated using algorithms revised for paediatric patients. Results Linked records of 129,719 hospital separations for 79,016 children were analysed. Identification of comorbid conditions was enhanced through access to prior and/or subsequent hospitalisation records (43% of children with pressure ulcers had a form of paralysis recorded only on a previous admission). Readmissions with a surgical wound infection were identified for 103 (4.8/1,000) surgical separations using linked data. After amendment of each algorithm for paediatric patients, rates of pressure ulcers and pneumonia reduced by 53% and 15% (from 1.3 to 0.6 and from 9.1 to 7.7 per 10,000 patient days) respectively, and an 84% increase in the proportion of surgical wound infection (from 5.7 to 10.4 per 1,000 separations). Conclusions Algorithms for nursing-sensitive outcomes used in adult populations have to be amended before application to paediatric populations. Using unlinked individual hospitalisation records to estimate rates of nursing-sensitive outcomes is likely to result in inaccurate rates.
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Affiliation(s)
- Sally Wilson
- School of Population Health, The University of Western Australia, 35 Stirling Hwy, Perth, Western, Australia.
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Adaptation and application of the Agency for Healthcare Research and Quality's asthma admission rate pediatric quality indicator to Ohio Medicaid claims data. Res Social Adm Pharm 2012; 9:240-50. [PMID: 22695214 DOI: 10.1016/j.sapharm.2012.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 04/13/2012] [Accepted: 04/15/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The U.S. Agency for Healthcare Research and Quality (AHRQ) developed, in the context of a national pediatric discharge database, 18 pediatric quality indicators (PDIs) for assessing pediatric care. These measures have not yet been adapted for and applied to claims databases. OBJECTIVES The objectives of this study were to (1) adapt the asthma admission rate (AAR) PDI methodology for claims data; (2) calculate AARs for Ohio Medicaid beneficiaries for 2007-2009, overall as well as by patient and regional characteristics; (3) determine the cost and length of stay associated with these hospitalizations; (4) describe medication use for 90 days before the hospitalizations; and (5) estimate the effect of asthma prevalence rates on AARs across Ohio counties. METHODS A retrospective study was performed using Ohio Medicaid claims data. After adapting the AHRQ methodology for a claims database, AARs were computed for the pediatric asthma population (aged 2-17 years). Total and mean costs and days spent in the hospital were calculated. A Poisson regression model was developed to estimate the effect of asthma prevalence on the AAR. RESULTS Between 2007 and 2009, the Ohio Medicaid AAR rose from 182 to 258 per 100,000 children. Costs (in 2009$) rose from $1,069,783 to $1,470,918, whereas hospital days increased from 672 to 815. Close to 70% of patients had no claims for a maintenance medication for 90 days before their hospitalization. The asthma prevalence rate was significantly associated with the AAR. CONCLUSIONS The remaining 17 PDIs could also be adapted for claims data to assess the quality of pediatric care.
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A systematic approach to improving medication safety in a pediatric intensive care unit. Crit Care Nurs Q 2012; 35:15-26. [PMID: 22157489 DOI: 10.1097/cnq.0b013e31823c25dd] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Safety and quality improvement are major issues in children's hospitals. Improving pediatric medication safety often takes on a larger role in pediatric units than in adult units due to the larger size differences and dose ranges found in a pediatric intensive care unit. This article reviews the literature and our own experience at the CS Mott Children's Hospital, University of Michigan, to improve medication safety. The issues identified include (1) an effective pediatric medication safety governance structure within a larger hospital, (2) practice standardization strategies for physicians, nurses, and pharmacists, (3) use of pharmacy technicians as unit medication managers, which reduces medication costs and decreases nursing time spent hunting for medications, and (4) methods to improve the safety culture in a pediatric intensive care unit.
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Kennedy A, Bakir C, Brauer CA. Quality indicators in pediatric orthopaedic surgery: a systematic review. Clin Orthop Relat Res 2012; 470:1124-32. [PMID: 21912995 PMCID: PMC3293946 DOI: 10.1007/s11999-011-2060-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The ability to measure health system quality has become a priority for governments, the private sector, and the public. Quality indicators (QIs) refer to clear, measurable items related to outcomes. The use of QIs can initiate local quality improvement and track changes in quality over time as interventions are implemented. QUESTIONS/PURPOSES We identified existing evidence-based indicators of quality pediatric orthopaedic care and evaluated published QIs that may be applicable to pediatric orthopaedic care. SEARCH STRATEGY Using five standard search engines we searched the literature using terms such as "quality indicators," "orthopaedic surgery," and "pediatric." Study selection was performed in a stepwise manner, first by title, then abstract, and then full-text review. Of the 604 citations identified, 13 articles were selected for inclusion. Eight papers included only pediatric patients. RESULTS The most commonly reported indicator was mortality followed by postoperative complications. Reoperation and readmission rates were also reported along with patient-centered QIs, although with less frequency. CONCLUSION Although mortality and postoperative complications were the most frequently reported QIs, concern for their applicability was raised because of their relative infrequency in pediatrics. Patient-centered QIs appear to be the most useful tools reported, although their use is somewhat limited in the published literature. Although there are benefits and drawbacks to all reported QIs, patient-centered and surgeon-defined outcomes along with cost-effectiveness have important roles in evaluating the quality of pediatric orthopaedic care.
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Affiliation(s)
- Angeliki Kennedy
- Division of Orthopaedic Surgery, Faculty of Medicine, University of Calgary, Calgary, AB Canada
| | - Christina Bakir
- Division of Orthopaedic Surgery, Faculty of Medicine, University of Calgary, Calgary, AB Canada
| | - Carmen A. Brauer
- Division of Orthopaedic Surgery, Faculty of Medicine, University of Calgary, Calgary, AB Canada
- Department of Surgery, University of Calgary, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8 Canada
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Chang DC, Rhee DS, Zhang Y, Salazar JH, Chrouser K, Choo S, Colombani PM, Abdullah F. Evaluating metrics for quality: death on the same day of elective pediatric surgery. Am J Med Qual 2012; 27:195-200. [PMID: 22294739 DOI: 10.1177/1062860611423727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgical mortality is considered a benchmark for measuring quality of care. This study quantifies the incidence of death on the day of elective pediatric surgery, which generally is considered preventable and might be considered a "never" event. The authors conducted a retrospective analysis of national state inpatient databases from 1988 to 2007 that included elective pediatric surgical patients. A descriptive analysis of same-day mortality by demographics, surgical specialties, and age was performed. Of 835 880 elective pediatric surgical cases identified, 174 patients died on the day of surgery-that is, 2.1 deaths/10 000 cases. Surgical specialty mortality rates ranged from 0.06 (otolaryngology) to 17.4 (cardiothoracic surgery) deaths per 10 000 cases. Death on the day of elective pediatric surgery is rare, limiting its utility to compare performance in pediatric surgery. However, this metric may be useful at individual institutions as a case-finding tool for root-cause analysis in quality improvement efforts.
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Affiliation(s)
- David C Chang
- University of California San Diego School of Medicine, CA, USA
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Foster RL, Park JH. An integrative review of literature examining psychometric properties of instruments measuring anxiety or fear in hospitalized children. Pain Manag Nurs 2011; 13:94-106. [PMID: 22652282 DOI: 10.1016/j.pmn.2011.06.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 06/22/2011] [Accepted: 06/28/2011] [Indexed: 11/17/2022]
Abstract
Anxiety and fear are among the most frequently reported emotional responses to hospitalization and are known to be contributing factors to pain and other negative patient outcomes. The first step in confronting unnecessary anxiety and fear is to identify valid and clinically feasible assessment instruments. The purpose of this paper is to review and evaluate instruments that measure children's fear or anxiety associated with hospitalization or painful procedures. A search was conducted of published English-language literature from 1980 through 2010 with the use of Ovid Health and Psychosocial Instruments, Medline, Nursing/Academic Edition, Cinahl, and Google Scholar. Inclusion criteria specified that the self-report instrument: 1) was developed in English; 2) was developed for and/or widely used with hospitalized children or children undergoing medical procedures or treatment; and 3) had research evidence of psychometric properties from at least five different studies. A comprehensive review of the literature revealed only five fear or anxiety instruments with adequate testing for evaluation of reliability and validity. Although all instruments have beginning psychometric adequacy, no one tool stands out as superior to the others. Therefore, we recommend that researchers and clinicians exercise caution in choosing assessment instruments, balancing potential strengths with reported limitations. Using more than one tool (triangulating) may be one way to achieve more credible results. Knowledge of credible existing instruments alerts us to what is possible today and to the imperative for research that will improve communication with children tomorrow.
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Affiliation(s)
- Roxie L Foster
- University of Colorado Denver College of Nursing, Aurora, Colorado, USA
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Tsang C, Palmer W, Bottle A, Majeed A, Aylin P. A Review of Patient Safety Measures Based on Routinely Collected Hospital Data. Am J Med Qual 2011; 27:154-69. [DOI: 10.1177/1062860611414697] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carmen Tsang
- Dr Foster Unit at Imperial College, Imperial College, London, UK
- Imperial Centre for Patient Safety and Service Quality, London, UK
| | - William Palmer
- Dr Foster Unit at Imperial College, Imperial College, London, UK
- National Audit Office, London, UK
| | - Alex Bottle
- Dr Foster Unit at Imperial College, Imperial College, London, UK
- Imperial Centre for Patient Safety and Service Quality, London, UK
| | | | - Paul Aylin
- Dr Foster Unit at Imperial College, Imperial College, London, UK
- Imperial Centre for Patient Safety and Service Quality, London, UK
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Van Cleave J, Dougherty D, Perrin JM. Strategies for addressing barriers to publishing pediatric quality improvement research. Pediatrics 2011; 128:e678-86. [PMID: 21844057 PMCID: PMC9923785 DOI: 10.1542/peds.2010-0809] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Advancing the science of quality improvement (QI) requires dissemination of the results of QI. However, the results of few QI interventions reach publication. OBJECTIVE To identify barriers to publishing results of pediatric QI research and provide practical strategies that QI researchers can use to enhance publishability of their work. METHODS We reviewed and summarized a workshop conducted at the Pediatric Academic Societies 2007 meeting in Toronto, Ontario, Canada, on conducting and publishing QI research. We also interviewed 7 experts (QI researchers, administrators, journal editors, and health services researchers who have reviewed QI manuscripts) about common reasons that QI research fails to reach publication. We also reviewed recently published pediatric QI articles to find specific examples of tactics to enhance publishability, as identified in interviews and the workshop. RESULTS We found barriers at all stages of the QI process, from identifying an appropriate quality issue to address to drafting the manuscript. Strategies for overcoming these barriers included collaborating with research methodologists, creating incentives to publish, choosing a study design to include a control group, increasing sample size through research networks, and choosing appropriate process and clinical quality measures. Several well-conducted, successfully published QI studies in pediatrics offer guidance to other researchers in implementing these strategies in their own work. CONCLUSION Specific, feasible approaches can be used to improve opportunities for publication in pediatric, QI, and general medical journals.
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Affiliation(s)
- Jeanne Van Cleave
- Center for Child and Adolescent Health Policy, Mass General Hospital for Children, Boston, Massachusetts 02114, USA.
| | | | - James M. Perrin
- Center for Child and Adolescent Health Policy, Mass General Hospital for Children, Boston, Massachusetts; and
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Tieder JS, Hall M, Auger KA, Hain PD, Jerardi KE, Myers AL, Rahman SS, Williams DJ, Shah SS. Accuracy of administrative billing codes to detect urinary tract infection hospitalizations. Pediatrics 2011; 128:323-30. [PMID: 21768320 PMCID: PMC3146355 DOI: 10.1542/peds.2010-2064] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hospital billing data are frequently used for quality measures and research, but the accuracy of the use of discharge codes to identify urinary tract infections (UTIs) is unknown. OBJECTIVE To determine the accuracy of International Classification of Diseases, 9th revision (ICD-9) discharge codes to identify children hospitalized with UTIs. METHODS This multicenter study conducted in 5 children's hospitals included children aged 3 days to 18 years who had been admitted to the hospital, undergone a urinalysis or urine culture, and discharged from the hospital. Data were obtained from the pediatric health information system database and medical record review. With the use of 2 gold-standard methods, the positive predictive value (PPV) was calculated for individual and combined UTI codes and for common UTI identification strategies. PPV was measured for all groupings for which the UTI code was the principal discharge diagnosis. RESULTS There were 833 patients in the study. The PPV was 50.3% with the use of the gold standard of laboratory-confirmed UTIs but increased to 85% with provider confirmation. Restriction of the study cohort to patients with a principle diagnosis of UTI improved the PPV for laboratory-confirmed UTI (61.2%) and provider-confirmed UTI (93.2%), as well as the ability to benchmark performance. Other common identification strategies did not markedly affect the PPV. CONCLUSIONS ICD-9 codes can be used to identify patients with UTIs but are most accurate when UTI is the principal discharge diagnosis. The identification strategies reported in this study can be used to improve the accuracy and applicability of benchmarking measures.
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Affiliation(s)
- Joel S. Tieder
- Department of Pediatrics, University of Washington School of Medicine and Division of Hospital Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Matthew Hall
- Child Health Corporation of America, Shawnee Mission, Kansas
| | - Katherine A. Auger
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Karen E. Jerardi
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Suraiya S. Rahman
- Hospital Medicine, Children's Mercy Hospital and Clinics, University of Missouri, Kansas City, Missouri
| | - Derek J. Williams
- General Pediatrics, Department of Pediatrics, Vanderbilt University, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Samir S. Shah
- Division of Infectious Diseases, Children's Hospital of Philadelphia and Departments of Pediatrics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Davies S, Romano PS, Schmidt EM, Schultz E, Geppert JJ, McDonald KM. Assessment of a novel hybrid Delphi and Nominal Groups technique to evaluate quality indicators. Health Serv Res 2011; 46:2005-18. [PMID: 21790589 DOI: 10.1111/j.1475-6773.2011.01297.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To test the implementation of a novel structured panel process in the evaluation of quality indicators. DATA SOURCE National panel of 64 clinicians rating usefulness of indicator applications in 2008-2009. STUDY DESIGN Hybrid panel combined Delphi Group and Nominal Group (NG) techniques to evaluate 81 indicator applications. PRINCIPAL FINDINGS The Delphi Group and NG rated 56 percent of indicator applications similarly. Group assignment (Delphi versus Nominal) was not significantly associated with mean ratings, but specialty and research interests of panelists, and indicator factors such as denominator level and proposed use were. Rating distributions narrowed significantly in 20.8 percent of applications between review rounds. CONCLUSIONS The hybrid panel process facilitated information exchange and tightened rating distributions. Future assessments of this method might include a control panel.
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Affiliation(s)
- Sheryl Davies
- Center for Primary Care and Outcomes Research, Stanford University CHP/PCOR, 117 Encina Commons, Stanford, CA 94305-6019, USA.
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Bethell CD, Kogan MD, Strickland BB, Schor EL, Robertson J, Newacheck PW. A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations. Acad Pediatr 2011; 11:S22-33. [PMID: 21570014 DOI: 10.1016/j.acap.2010.08.011] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 08/19/2010] [Accepted: 08/27/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Parent/consumer-reported data is valuable and necessary for population-based assessment of many key child health and health care quality measures relevant to both the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 and the Patient Protection and Affordable Care Act of 2010 (ACA). OBJECTIVES The aim of this study was to evaluate national and state prevalence of health problems and special health care needs in US children; to estimate health care quality related to adequacy and consistency of insurance coverage, access to specialist, mental health and preventive medical and dental care, developmental screening, and whether children meet criteria for having a medical home, including care coordination and family centeredness; and to assess differences in health and health care quality for children by insurance type, special health care needs status, race/ethnicity, and/or state of residence. METHODS National and state level estimates were derived from the 2007 National Survey of Children's Health (N = 91,642; children aged 0-17 years). Variations between children with public versus private sector health insurance, special health care needs, specific conditions, race/ethnicity, and across states were evaluated using multivariate logistic regression and/or standardized statistical tests. RESULTS An estimated 43% of US children (32 million) currently have at least 1 of 20 chronic health conditions assessed, increasing to 54.1% when overweight, obesity, or being at risk for developmental delays are included; 19.2% (14.2 million) have conditions resulting in a special health care need, a 1.6 point increase since 2003. Compared with privately insured children, the prevalence, complexity, and severity of health problems were systematically greater for the 29.1% of all children who are publicly insured children after adjusting for variations in demographic and socioeconomic factors. Forty-five percent of all children in the United States scored positively on a minimal quality composite measure: 1) adequate insurance, 2) preventive care visit, and 3) medical home. A 22.2 point difference existed across states and there were wide variations by health condition (autism, 22.8, to asthma, 39.4). After adjustment for demographic and health status differences, quality of care varied between children with public versus private health insurance on all but the following 3 measures: not receiving needed mental health services, care coordination, and performance on the minimal quality composite. A 4.60 fold (gaps in insurance) to 1.27 fold (preventive dental and medical care visits) difference in quality scores was observed across states. Notable disparities were observed among publicly insured children according to race/ethnicity and across all children by special needs status and household income. CONCLUSIONS Findings emphasize the importance of health care insurance duration and adequacy, health care access, chronic condition management, and other quality of care goals reflected in the 2009 CHIPRA legislation and the ACA. Despite disparities, similarities for public and privately insured children speak to the pervasive nature of availability, coverage, and access issues for mental health services in the United States, as well as the system-wide problem of care coordination and accessing specialist care for all children. Variations across states in key areas amenable to state policy and program management support cross-state learning and improvement efforts.
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Affiliation(s)
- Christina D Bethell
- Department of Pediatrics, School of Medicine, Oregon Health & Science University, 707 SW Gaines Street, Mailcode CDRCP, Portland, Oregon 97239, USA.
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Chang DC, Rhee DS, Papandria D, Aspelund G, Cowles RA, Huang EY, Chen C, Middlesworth W, Arca MJ, Abdullah F. Outcomes research in pediatric surgery. Part 2: how to structure a research question. J Pediatr Surg 2011; 46:226-31. [PMID: 21238673 DOI: 10.1016/j.jpedsurg.2010.09.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 09/30/2010] [Indexed: 11/17/2022]
Abstract
Innovative treatments and procedures are essential to the advancement of surgery. Outcomes research provides the mechanism to analyze these new treatments as they enter clinical practice and evaluate them against established therapies. Information gained through this methodology is essential because new techniques and innovations often gain rapid acceptance before clinical trials can be conducted to assess them. Increasing national emphasis is placed on comparative effectiveness as health care costs rise. Surgeons must take the lead in surgical outcomes and comparative effectiveness research, with the goal of identifying the most efficient and effective treatment for our patients. The authors show how to structure and design a research project involving pediatric surgical outcomes. The model consists of the following 3 phases: (1) study design, (2) data preparation, and (3) data analysis. The model we present provides the reader with a basic format and research structure to serve as a guide to performing high-quality surgical outcomes research.
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Affiliation(s)
- David C Chang
- Department of Surgery, University of California San Diego School of Medicine, San Diego, CA 92103, USA
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Bardach NS, Chien AT, Dudley RA. Small numbers limit the use of the inpatient pediatric quality indicators for hospital comparison. Acad Pediatr 2010; 10:266-73. [PMID: 20599180 PMCID: PMC2897835 DOI: 10.1016/j.acap.2010.04.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 04/12/2010] [Accepted: 04/17/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to determine the percentage of hospitals with adequate sample size to meaningfully compare performance by using the Agency for Healthcare Research and Quality (AHRQ) pediatric quality indicators (PDIs), which measure pediatric inpatient adverse events such as decubitus ulcer rate and infections due to medical care, have been nationally endorsed, and are currently publicly reported in at least 2 states. METHODS We performed a cross-sectional analysis of California hospital discharges from 2005-2007 for patients aged <18 years. For 9 hospital-level PDIs, after excluding discharges with PDIs indicated as present on admission, we determined for each PDI the volume of eligible pediatric patients for each measure at each hospital, the statewide mean rate, and the percentage of hospitals with adequate volume to identify an adverse event rate twice the statewide mean. RESULTS Unadjusted California-wide event rates for PDIs during the study period (N = 2 333 556 discharges) were 0.2 to 38 per 1000 discharges. Event rates for specific measures were, for example, 0.2 per 1000 (iatrogenic pneumothorax in non-neonates), 19 per 1000 (postoperative sepsis), and 38 per 1000 (pediatric heart surgery mortality), requiring patient volumes of 49 869, 419, and 201 to detect an event rate twice the statewide average; 0%, 6.6%, and 25%, respectively, of California hospitals had this pediatric volume. CONCLUSION Using these AHRQ-developed, nationally endorsed measures of the quality of inpatient pediatric care, one would not be able to identify many hospitals with performance 2 times worse than the statewide average due to extremely low event rates and inadequate pediatric hospital volume.
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Affiliation(s)
- Naomi S Bardach
- Department of General Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, USA.
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Gouvêa CSDD, Travassos C. Indicadores de segurança do paciente para hospitais de pacientes agudos: revisão sistemática. CAD SAUDE PUBLICA 2010; 26:1061-78. [DOI: 10.1590/s0102-311x2010000600002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 03/24/2010] [Indexed: 11/22/2022] Open
Abstract
Foi realizada uma revisão sistemática para identificar as estratégias utilizadas no desenvolvimento de indicadores de segurança do paciente para hospitais de pacientes agudos. As fontes de dados utilizadas foram: MEDLINE, EMBASE, sítios na Internet e referências bibliográficas dos documentos selecionados. Foram incluídos 14 projetos de desenvolvimento de indicadores. O uso de diversos termos relacionados à qualidade e segurança do paciente foi observado com definições variadas. A revisão da literatura e a participação de especialistas e outras representações caracterizaram os projetos. Dos 285 indicadores identificados, 125 foram classificados em mais de uma dimensão da qualidade. A combinação mais freqüente foi segurança e efetividade. Identificou-se um número maior de indicadores sobre medicamentos, e a maioria representa informações de resultado. Observou-se a importância de considerar no desenvolvimento dos indicadores variações culturais, da prática clínica, a disponibilidade dos sistemas de informação e a capacidade de hospitais para implementar sistemas de monitoramento efetivos.
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Tracy ET, Bennett KM, Danko ME, Diesen DL, Westmoreland TJ, Kuo PC, Pappas TN, Rice HE, Scarborough JE. Low volume is associated with worse patient outcomes for pediatric liver transplant centers. J Pediatr Surg 2010; 45:108-13. [PMID: 20105589 DOI: 10.1016/j.jpedsurg.2009.10.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 10/06/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND An inverse association between hospital procedure volume and postoperative mortality has been demonstrated for a variety of pediatric surgical procedures. The objective of our study was to determine whether such an association exists for pediatric liver transplantation. METHODS We performed a retrospective analysis of pediatric liver transplant procedures included in the Scientific Registry of Transplant Recipients over a 7.5-year time period from July 1, 2000, through December 31, 2007. Pediatric liver transplant centers were divided into three volume categories (high, middle, low) based on absolute annual volume. Mean 1-year patient survival rates and aggregate 1-year observed-to-expected (O:E) patient death ratios were calculated for each hospital volume category and then compared using ordered logistic regression and chi square analyses. RESULTS High-volume pediatric liver transplant centers achieved significantly lower aggregate 1-year O:E patient death ratios than low-volume centers. When freestanding children's hospitals (FCH), children's hospitals within adult hospitals (CAH), and other centers (OC) were considered separately, we found that a significant volume-outcomes association existed among OC centers but not among FCH or CAH centers. Low-volume OC centers, which represent 41.6% of all pediatric liver transplant centers and perform 10% of all pediatric liver transplantation, had the least favorable aggregate 1-year O:E patient death ratio of all groups. CONCLUSIONS We demonstrate that a significant center volume-outcomes relationship exists among OC pediatric liver transplant centers but not among FCH or CAH centers. These findings support the possible institution of minimum annual procedure volume requirements for OC pediatric liver transplant centers.
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Affiliation(s)
- Elisabeth T Tracy
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Saxena S, Bottle A, Gilbert R, Sharland M. Increasing short-stay unplanned hospital admissions among children in England; time trends analysis '97-'06. PLoS One 2009; 4:e7484. [PMID: 19829695 PMCID: PMC2758998 DOI: 10.1371/journal.pone.0007484] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 09/10/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Timely care by general practitioners in the community keeps children out of hospital and provides better continuity of care. Yet in the UK, access to primary care has diminished since 2004 when changes in general practitioners' contracts enabled them to 'opt out' of providing out-of-hours care and since then unplanned pediatric hospital admission rates have escalated, particularly through emergency departments. We hypothesised that any increase in isolated short stay admissions for childhood illness might reflect failure to manage these cases in the community over a 10 year period spanning these changes. METHODS AND FINDINGS We conducted a population based time trends study of major causes of hospital admission in children <10 years using the Hospital Episode Statistics database, which records all admissions to all NHS hospitals in England using ICD10 codes. Outcomes measures were total and isolated short stay unplanned hospital admissions (lasting less than 2 days without readmission within 28 days) from 1997 to 2006. Over the period annual unplanned admission rates in children aged <10 years rose by 22% (from 73.6/1000 to 89.5/1000 child years) with larger increases of 41% in isolated short stay admissions (from 42.7/1000 to 60.2/1000 child years). There was a smaller fall of 12% in admissions with length of stay of >2 days. By 2006, 67.3% of all unplanned admissions were isolated short stays <2 days. The increases in admission rates were greater for common non-infectious than infectious causes of admissions. CONCLUSIONS Short stay unplanned hospital admission rates in young children in England have increased substantially in recent years and are not accounted for by reductions in length of in-hospital stay. The majority are isolated short stay admissions for minor illness episodes that could be better managed by primary care in the community and may be evidence of a failure of primary care services.
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Affiliation(s)
- Sonia Saxena
- Department of Primary Care and Social Medicine, Imperial College London, London, United Kingdom.
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McDonald KM. Approach to improving quality: the role of quality measurement and a case study of the agency for healthcare research and quality pediatric quality indicators. Pediatr Clin North Am 2009; 56:815-29. [PMID: 19660629 DOI: 10.1016/j.pcl.2009.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Data and well-constructed measures quantify suboptimal quality in health care and play a crucial role in improving quality. Measures are useful for three major purposes: (1) driving improvements in outcomes of care by prioritizing and selecting appropriate interventions, (2) developing comparative quality reports for consumer and payer decision making and health system accountability, and (3) creating incentives that pay for performance. This article describes the current landscape for measurement in pediatrics compared to adult care, provides a case study of the development and application of a publicly available and federally funded pediatric indicator set using routinely collected hospital discharge data, and addresses challenges and opportunities in selecting and using measures as a function of intended purpose.
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Affiliation(s)
- Kathryn M McDonald
- Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA 94305-6019, USA.
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