Measuring and Mapping National Pediatric Acute Care Outcomes

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PROJECT SUMMARY/ABSTRACT Across 25 million emergency department (ED) visits annually, children experience widely variable care due to major differences in readiness and capabilities between EDs. These differences bear on the likelihood that a patient will receive an accurate diagnosis and timely, high-quality treatment. Measuring outcomes across the entire national pediatric acute care system has proved difficult because granular, national, geocoded healthcare data have been unavailable; investigators have focused on individual diseases; regional healthcare maps are outdated; challenges abound with risk adjustment for individuals’ personal risk; and because each disease requires a different approach to measure its outcomes. Further complicating efforts is the complex network of relationships between hospitals in which multiple facilities share responsibility for outcomes. These relationships are substantially different between adult and child patients, and there is no working understanding of the structure of the national pediatric network. This proposal will overcome those challenges to create the Atlas of Pediatric Acute Care, a comprehensive examination of the acute care outcomes of 37.7 million children across the nation, which represents half of the US child population. The Atlas will map regional hospital systems using sophisticated network analysis algorithms known as community detection. The map that results will define regions of pediatric care in which there is a shared responsibility for care. It will be used to determine regional outcomes across three serious conditions in children: appendicitis (the most common surgical condition in children), neurotrauma (the most common cause of serious injury), and sepsis (a notoriously difficult-to-diagnose condition that is one of the costliest). This knowledge will then provide the basis to compare regional systems to elucidate the factors associated with high performance. We will also use the highest-quality methods to understand costs, using actual patient and payer expenditures, across US pediatric regions. This proposal reflects the priorities of the Eunice Kennedy Shriver National Institute of Child Health and Human Development: to use “large-scale datasets to optimize outcomes for traumatized, injured, and critically ill children” and to “examine the epidemiology and treatment of all forms of critical illness.” Focusing efforts to improve outcomes nationally has the potential to improve the population health, but depends on an accurate, multi-disease understanding of outcomes. The Atlas will provide such an understanding and will emerge as an enduring resource to support efforts to improve pediatric acute care, which will translate to better survival and higher quality of life for the nation’s children.