Small numbers limit the use of the inpatient pediatric quality indicators for hospital comparison.
Small numbers limit the use of the inpatient pediatric quality indicators for hospital comparison.
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DOI：
10.1016/j.acap.2010.04.025
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发表时间：
2010-07
影响因子：
3.1
通讯作者：
Dudley, R. Adams
中科院分区：
文献类型：
--
作者：
Bardach, Naomi S.;Chien, Alyna T.;Dudley, R. Adams
为了确定具有足够样本量的医院的百分比，以有意义地比较使用医疗保健研究和质量机构(AHRQ)的儿科住院患者质量指标(PDI)，该指标衡量儿科住院患者的不良事件，如压疮发生率和因医疗而引起的感染，已得到全国认可，目前至少在两个州公开报告。我们对2005-2007年间加州医院出院的18岁患者进行了横断面分析。对于9个医院级别的PDI，在排除入院时显示为存在的PDI的出院后，我们为每个PDI确定：每个医院每项指标的合格儿科患者的数量、全州平均比率以及具有足够容量以确定不良事件发生率是全州平均水平两倍的医院的百分比。在研究期间(N=2,333,556次放电)，未经调整的加州范围内PDI的事故率为0.2-38/1000次放电。例如，特定措施的事件发生率为0.2/1000(非新生儿医源性气胸)、19/1000(术后脓毒症)和38/1000(儿科心脏手术死亡率)，需要患者数量为49,869、419和201才能检测到事件发生率是全州平均水平的两倍；加州医院的儿科患者数量分别为0%、6.6%和25%。使用AHRQ开发的、国家认可的住院儿科护理质量衡量标准，人们将无法确定许多医院的表现比全州平均水平差两倍，原因是事件发生率极低，儿科医院容量不足。
To determine the percentage of hospitals with adequate sample size to meaningfully compare performance using the Agency for Healthcare Research and Quality (AHRQ) pediatric inpatient 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 two states. We performed a cross-sectional analysis of California hospital discharges from 2005–2007 for patients <18 years old. For nine 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 percent of hospitals with adequate volume to identify an adverse event rate twice the statewide mean. Unadjusted California-wide event rates for PDIs during the study period (N=2,333,556 discharges) were 0.2-38/1000 discharges. Event rates for specific measures were, for example, 0.2/1000 (iatrogenic pneumothorax in non-neonates), 19/1000 (post-operative sepsis) and 38/1000 (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% of California hospitals had this pediatric volume, respectively. 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 two times worse than the statewide average due to extremely low event rates and inadequate pediatric hospital volume.
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影响因子：
8
作者：
Miller, MR;Zhan, CL
通讯作者：
Zhan, CL
影响因子：
8
作者：
McDonald, Kathryn M.;Davies, Sheryl M.;Romano, Patrick S.
通讯作者：
Romano, Patrick S.
影响因子：
3
作者：
Hofer, TP;Hayward, RA
通讯作者：
Hayward, RA
DOI：
10.1367/a04-229r.1
发表时间：
2005-09-01
期刊：
AMBULATORY PEDIATRICS
影响因子：
--
作者：
Miller, MR;Gergen, P;Zhan, CL
通讯作者：
Zhan, CL
DOI：
10.5034/inquiryjrnl_44.2.137
发表时间：
2007-06-01
影响因子：
1.7
作者：
Goldman, L. Elizabeth;Henderson, Stuart;Dudley, R. Adams
通讯作者：
Dudley, R. Adams