Pediatric Respiratory Illness Measurement System (PRIMES) Implementation in Community Hospital Settings

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Acute respiratory illness is a major cause of hospitalizations in the pediatric population with over 75% of admissions occurring in community–based (non-children's) hospitals. Focusing inpatient quality improvement (QI) efforts on these conditions is likely to have a significant impact on outcomes. The Pediatric Respiratory Illness Measurement System-Short Version (PRIMES-SV) tool is an abbreviated version of the previously developed and validated PRIMES quality assessment tool. Using medical records data, PRIMES-SV generates quality scores for both asthma and bronchiolitis, two of the most common conditions diagnosed in children admitted to community hospitals. The overall goals of this study are to demonstrate the sensitivity of PRIMES-SV measures to quality improvement (QI) interventions in community hospital settings, and to better understand the contextual and provider-level factors associated with both the ability to improve performance and to sustain those improvements. The specific aims of the study are: Aim 1. To implement the PRIMES-SV tool in six geographically diverse community hospitals to a) examine the degree of variation in performance across the hospitals and b) identify implementation barriers to high performance using the Consolidated Framework for Implementation Research (CFIR); Aim 2.To a) conduct a QI collaborative and improve overall performance on a sub-set of PRIMES-SV measures among the six hospitals by targeting CFIR-linked barriers with aligned strategies, and b) assess whether improved performance is associated with decreased LOS and costs; and Aim 3. To a) assess whether observed performance improvements are sustained on the targeted PRIMES-SV measures and b) determine which CFIR factors are linked with sustainment. These aims will be accomplished by bringing together a diverse group of experts in the fields of QI evaluation research, implementation science, and pediatric community-based hospital medicine. If using the proposed approach to QI is successful and improvements are sustained, the PRIMES-SV quality assessment tool used in combination with CFIR barrier-strategy matching could be widely disseminated to both community and children's hospitals to facilitate quality improvement for these common and high cost pediatric conditions.