Developing Quality Measures to Assess Pediatric Inpatient Respiratory Care

制定评估儿科住院呼吸护理的质量措施

• 批准号: 7584354
• 负责人: RITA MANGIONE-SMITH
• 金额: $ 54.61万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7584354
• 关键词: Acute; Adherence; Admission activity; Ambulatory Care; Americas; Asthma; Bronchiolitis; Caring; Child; Child Care; Child health care; Childhood; Chronic; Clinical Practice Guideline; Croup; Cystic Fibrosis; Data; Data Quality; Data Sources; Databases; Evaluation; Health Information System; Health Services; Health Status; Hospitalized Child; Hospitals; Inpatients; Location; Los Angeles; Lung; Lung diseases; Measurement; Measures; Medical Records; Medical center; Methods; Outcome; Outpatients; Patients; Pediatric Hospitals; Phase; Pneumonia; Population; Process; Publishing; Quality Indicator; Quality of Care; Recommendation; Respiratory Failure; Review Literature; Risk; Secondary to; Structure; Testing; United States; Variant; Youth; base; burden of illness; design; evidence base; health care service utilization; health related quality of life; improved; malformation; public health relevance; respiratory; tool

DESCRIPTION (provided by applicant): Acute and chronic respiratory illness represent a substantial proportion of childhood disease burden in the United States. Approximately 16% of admissions to U.S. children's hospitals are secondary to respiratory disease. Significant gaps exist between evidence-based clinical practice guidelines and the health services provided to the nation's youth. Results of the first comprehensive evaluation of outpatient pediatric quality of care found U.S. children on average receive only 46% of recommended care; just 45% of recommended care for asthma was received. No similar data exist for hospitalized children. While this level of adherence to standards for ambulatory care is disturbing, the impact of poor quality of care on hospitalized children, especially those at increased risk for respiratory failure, is likely to have more serious consequences. Our main objectives are to develop a rigorously designed quality of care assessment tool that can be used to examine the degree to which hospitals caring for children are adhering to recommended standards of care for respiratory illness and to determine the feasibility and validity of using administrative data to make these assessments. Specifically, we will use the RAND/UCLA modified Delphi method to develop a quality of care assessment tool for pediatric respiratory illness. We will then use the tool to conduct a detailed assessment of inpatient management for children treated for six respiratory conditions: asthma, bronchiolitis, croup, pneumonia, congenital lung malformations, and cystic fibrosis. The tool developed will be structured to generate quality scores using medical records data. First, we will conduct a detailed assessment of the inpatient management of 3,000 children admitted to three U.S. children's hospitals: Cincinnati Children's Hospital Medical Center, Children's Hospital Los Angeles, and Seattle Children's Hospital and Regional Medical Center. Second, we will examine the comparability of quality scores obtained using medical records versus administrative data for quality measurement. Finally, we will examine the relationship between quality scores and child health related quality of life to outcome-validate our quality assessment tool. This study will result in a rigorously designed, disseminable quality assessment tool that can be used by hospitals treating children for respiratory illness to both track and improve on the quality of care they provide. PUBLIC HEALTH RELEVANCE: The quality of care assessment tool we propose to develop in this study will be the first measurement tool available to rigorously and comprehensively evaluate inpatient pediatric care for children with respiratory illness. Without such measurement tools, it is not possible to assess where deficits exist and how to target efforts to best improve care. This tool will be designed for dissemination and use among all hospitals caring for children nationally.

描述（由申请人提供）：在美国，急性和慢性呼吸道疾病占儿童疾病负担的很大比例。美国儿童医院约有16%的住院病人是继发于呼吸系统疾病。循证临床实践指南与向全国青年提供的卫生服务之间存在重大差距。对门诊儿科护理质量的首次综合评估结果发现，美国儿童平均只接受了46%的推荐护理;哮喘仅接受了45%的推荐护理。住院儿童没有类似的数据。虽然对门诊护理标准的这种遵守程度令人不安，但护理质量差对住院儿童的影响，特别是那些呼吸衰竭风险增加的儿童，可能会产生更严重的后果。我们的主要目标是开发一个严格设计的护理质量评估工具，可用于检查医院照顾儿童的程度，坚持推荐的标准，呼吸系统疾病的护理，并确定使用管理数据进行这些评估的可行性和有效性。具体而言，我们将使用兰德/加州大学洛杉矶分校的修改德尔菲方法，以开发一个儿科呼吸系统疾病的护理质量评估工具。然后，我们将使用该工具对治疗六种呼吸系统疾病的儿童的住院管理进行详细评估：哮喘，细支气管炎，哮吼，肺炎，先天性肺畸形和囊性纤维化。开发的工具将采用医疗记录数据生成质量评分。首先，我们将对美国三家儿童医院收治的3,000名儿童的住院管理情况进行详细评估：辛辛那提儿童医院医疗中心、洛杉矶儿童医院和西雅图儿童医院和地区医疗中心。第二，我们将检查使用医疗记录与行政数据获得的质量评分的可比性。最后，我们将研究质量分数和儿童健康相关的生活质量之间的关系，以验证我们的质量评估工具。这项研究将产生一个严格设计的，可传播的质量评估工具，可用于治疗儿童呼吸道疾病的医院，以跟踪和提高他们提供的护理质量。公共卫生关系：我们建议在本研究中开发的护理质量评估工具将是第一个可用于严格和全面评估呼吸系统疾病儿童住院儿科护理的测量工具。如果没有这种衡量工具，就不可能评估哪里存在缺陷，以及如何有针对性地努力以最佳方式改善护理。该工具将在全国所有儿童护理医院中传播和使用。