McDonald Kathryn M, Davies Sheryl M, Haberland Corinna A, Geppert Jeffrey J, Ku Amy, Romano Patrick S
Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, USA.
Pediatrics. 2008 Aug;122(2):e416-25. doi: 10.1542/peds.2007-2477.
With >6 million hospital stays, costing almost $50 billion annually, hospitalized children represent an important population for which most inpatient quality indicators are not applicable. Our aim was to develop indicators using inpatient administrative data to assess aspects of the quality of inpatient pediatric care and access to quality outpatient care.
We adapted the Agency for Healthcare Research and Quality quality indicators, a publicly available set of measurement tools refined previously by our team, for a pediatric population. We systematically reviewed the literature for evidence regarding coding and construct validity specific to children. We then convened 4 expert panels to review and discuss the evidence and asked them to rate each indicator through a 2-stage modified Delphi process. From the 2000 and 2003 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Kids' Inpatient Database, we generated national estimates for provider level indicators and for area level indicators.
Panelists recommended 18 indicators for inclusion in the pediatric quality indicator set based on overall usefulness for quality improvement efforts. The indicators included 13 hospital-level indicators, including 11 based on complications, 1 based on mortality, and 1 based on volume, as well as 5 area-level potentially preventable hospitalization indicators. National rates for all 18 of the indicators varied minimally between years. Rates in high-risk strata are notably higher than in the overall groups: in 2003 the decubitus ulcer pediatric quality indicator rate was 3.12 per 1000, whereas patients with limited mobility experienced a rate of 22.83. Trends in rates by age varied across pediatric quality indicators: short-term complications of diabetes increased with age, whereas admissions for gastroenteritis decreased with age.
Tracking potentially preventable complications and hospitalizations has the potential to help prioritize quality improvement efforts at both local and national levels, although additional validation research is needed to confirm the accuracy of coding.
每年有超过600万儿童住院，花费近500亿美元，住院儿童是一个重要群体，但大多数住院质量指标并不适用于他们。我们的目标是利用住院管理数据制定指标，以评估儿科住院护理质量以及获得优质门诊护理的情况。
我们将医疗保健研究与质量机构的质量指标（这是一套此前由我们团队完善的公开可用测量工具）改编用于儿科人群。我们系统回顾了文献，以获取有关儿童特定编码和结构效度的证据。然后我们召集了4个专家小组来审查和讨论这些证据，并要求他们通过两阶段改进的德尔菲法对每个指标进行评分。从2000年和2003年医疗保健研究与质量机构的医疗成本与利用项目儿童住院数据库中，我们得出了提供者层面指标和地区层面指标的全国估计值。
专家小组成员基于对质量改进工作的总体有用性，推荐了18项指标纳入儿科质量指标集。这些指标包括13项医院层面指标，其中11项基于并发症，1项基于死亡率，1项基于数量，以及5项地区层面潜在可预防住院指标。所有18项指标的全国发生率在不同年份之间变化极小。高危阶层的发生率明显高于总体群体：2003年，儿童压疮质量指标发生率为每1000人中有3.12例，而行动不便的患者发生率为22.83例。不同儿科质量指标的年龄别发生率趋势各不相同：糖尿病短期并发症随年龄增加，而肠胃炎入院率随年龄下降。
追踪潜在可预防的并发症和住院情况有可能有助于在地方和国家层面确定质量改进工作的优先次序，不过还需要额外的验证研究来确认编码的准确性。
