Developing Quality Measures to Assess Pediatric Inpatient Respiratory Care

描述(申请人提供)：急性和慢性呼吸道疾病在美国儿童疾病负担中占相当大的比例。美国儿童医院大约16%的入院者是呼吸道疾病的继发性患者。循证临床实践指南与为该国青年提供的卫生服务之间存在重大差距。首次全面评估门诊儿科护理质量的结果发现，美国儿童平均只得到46%的推荐护理；只有45%的哮喘推荐护理得到了推荐。住院儿童没有类似的数据。虽然对门诊护理标准的遵守程度令人不安，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种严格设计的护理质量评估工具，可用于检查护理儿童的医院在多大程度上遵守推荐的呼吸道疾病护理标准，并确定使用行政数据进行这些评估的可行性和有效性。具体地说，我们将使用兰德/加州大学洛杉矶分校改进的德尔菲方法来开发一种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接受六种呼吸系统疾病治疗的儿童的住院管理进行详细评估：哮喘、毛细支气管炎、哮喘、肺炎、先天性肺畸形和囊性纤维化。开发的工具将被构建为使用医疗记录数据生成质量分数。首先，我们将对美国三家儿童医院--辛辛那提儿童医院医疗中心、洛杉矶儿童医院、西雅图儿童医院和地区医疗中心--的3000名儿童的住院管理进行详细评估。其次，我们将检查使用医疗记录获得的质量分数与用于质量测量的行政数据的可比性。最后，我们将检查质量分数与儿童健康相关生活质量之间的关系，以验证我们的质量评估工具的结果。这项研究将产生一个设计严谨、可传播的质量评估工具，治疗呼吸道疾病的儿童的医院可以使用该工具来跟踪和改进他们提供的护理质量。公共卫生相关性：我们在这项研究中建议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患有呼吸系统疾病的儿童住院儿科护理的衡量工具。如果没有这样的衡量工具，就不可能评估哪里存在赤字，以及如何针对最好地改善护理的努力。这一工具将在全国所有照顾儿童的医院中传播和使用。

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.