Preliminary assessment of pediatric health care quality and patient safety in the United States using readily available administrative data
Preliminary assessment of pediatric health care quality and patient safety in the United States using readily available administrative data
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DOI：
10.1542/peds.2007-2477
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发表时间：
2008-08-01
期刊：
影响因子：
8
通讯作者：
Romano, Patrick S.
中科院分区：
文献类型：
--
作者：
McDonald, Kathryn M.;Davies, Sheryl M.;Romano, Patrick S.
目标.住院儿童超过600万次，每年花费近500亿美元，是一个重要的人口群体，大多数住院质量指标都不适用。我们的目的是使用住院管理数据来制定指标，以评估住院儿科护理质量和获得优质门诊护理的各个方面。我们调整了医疗保健研究和质量质量指标机构，这是一套公开可用的测量工具，我们的团队以前改进过，用于儿科人群。我们系统地回顾了文献，以寻找有关儿童特定编码和结构效度的证据。然后，我们召集了4个专家小组对证据进行审查和讨论，并要求他们通过两阶段改良的德尔菲过程对每个指标进行评分。从2000年和2003年的医疗保健研究和质量医疗保健成本和利用项目儿童住院病人数据库机构，我们产生了全国估计的供应商水平的指标和地区水平的指标。专家组成员建议将18项指标纳入儿科质量指标集的基础上，质量改进工作的整体有用性。这些指标包括13个医院一级的指标，其中11个基于并发症，1个基于死亡率，1个基于数量，以及5个地区一级潜在可预防的住院指标。所有18项指标的国家比率在不同年份之间变化很小。高风险人群的发生率明显高于总体人群：2003年，褥疮性溃疡儿科质量指标发生率为3.12/1000，而活动受限患者的发生率为22.83/1000。各年龄段的比率趋势在儿科质量指标中各不相同：糖尿病的短期并发症随年龄增长而增加，而胃肠炎的入院率随年龄增长而下降。跟踪潜在可预防的并发症和住院有可能帮助优先考虑地方和国家层面的质量改进工作，尽管需要额外的验证研究来确认编码的准确性。
OBJECTIVES. With > 6 million hospital stays, costing almost $50 billion annually, hospitalized children represent an important population for which most inpatient quality indicators are not applicable. Our aim was to develop indicators using inpatient administrative data to assess aspects of the quality of inpatient pediatric care and access to quality outpatient care.METHODS. We adapted the Agency for Healthcare Research and Quality quality indicators, a publicly available set of measurement tools refined previously by our team, for a pediatric population. We systematically reviewed the literature for evidence regarding coding and construct validity specific to children. We then convened 4 expert panels to review and discuss the evidence and asked them to rate each indicator through a 2-stage modified Delphi process. From the 2000 and 2003 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Kids' Inpatient Database, we generated national estimates for provider level indicators and for area level indicators.RESULTS. Panelists recommended 18 indicators for inclusion in the pediatric quality indicator set based on overall usefulness for quality improvement efforts. The indicators included 13 hospital-level indicators, including 11 based on complications, 1 based on mortality, and 1 based on volume, as well as 5 area-level potentially preventable hospitalization indicators. National rates for all 18 of the indicators varied minimally between years. Rates in high-risk strata are notably higher than in the overall groups: in 2003 the decubitus ulcer pediatric quality indicator rate was 3.12 per 1000, whereas patients with limited mobility experienced a rate of 22.83. Trends in rates by age varied across pediatric quality indicators: short-term complications of diabetes increased with age, whereas admissions for gastroenteritis decreased with age.CONCLUSIONS. Tracking potentially preventable complications and hospitalizations has the potential to help prioritize quality improvement efforts at both local and national levels, although additional validation research is needed to confirm the accuracy of coding.