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

急性呼吸道疾病是儿科人群住院的主要原因， 社区医院（非儿童医院）的住院情况。聚焦住院质量提升 (QI)在这些条件下作出的努力可能会对结果产生重大影响。儿科呼吸 疾病测量系统-简短版（PRIMES-SV）工具是以前的 开发并验证PRIMES质量评估工具。使用医疗记录数据，PRIMES-SV 生成哮喘和细支气管炎的质量评分，这两种最常见的疾病是在 社区医院收治的儿童。本研究的总体目标是证明 PRIMES-SV措施，以改善社区医院环境中的质量改进（QI）干预措施， 了解与提高性能的能力相关的上下文和提供者级别的因素 并保持这些改进。 研究的具体目标是：目标1。在六个不同地理区域实施PRIMES-SV工具， 社区医院a）检查医院间绩效的差异程度，以及B）确定 利用实施研究综合框架实现高绩效的实施障碍 （CFIR）;目标2. a）进行QI协作，提高PRIMES-SV子集的整体性能 在六家医院中通过针对CFIR相关的障碍与一致的策略来采取措施，以及B）评估 改进的性能是否与降低的服务水平和成本相关;以及目标3。A.评估是否 在目标PRIMES-SV测量上持续观察到的性能改进，并且B）确定 哪些CFIR因素与维持有关。 这些目标将通过汇集QI领域的各种专家来实现 评价研究、实施科学和儿科社区医院医学。如果使用 建议的QI方法是成功的，改进是持续的，PRIMES-SV质量评估 与CFIR障碍-策略匹配结合使用的工具可以广泛传播到两个社区 和儿童医院，以促进这些常见和高成本的儿科条件的质量改进。

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.