Department of General Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, USA.
Acad Pediatr. 2010 Jul-Aug;10(4):266-73. doi: 10.1016/j.acap.2010.04.025.
The aim of this study was to determine the percentage of hospitals with adequate sample size to meaningfully compare performance by using the Agency for Healthcare Research and Quality (AHRQ) pediatric quality indicators (PDIs), which measure pediatric inpatient adverse events such as decubitus ulcer rate and infections due to medical care, have been nationally endorsed, and are currently publicly reported in at least 2 states.
We performed a cross-sectional analysis of California hospital discharges from 2005-2007 for patients aged <18 years. For 9 hospital-level PDIs, after excluding discharges with PDIs indicated as present on admission, we determined for each PDI the volume of eligible pediatric patients for each measure at each hospital, the statewide mean rate, and the percentage of hospitals with adequate volume to identify an adverse event rate twice the statewide mean.
Unadjusted California-wide event rates for PDIs during the study period (N = 2 333 556 discharges) were 0.2 to 38 per 1000 discharges. Event rates for specific measures were, for example, 0.2 per 1000 (iatrogenic pneumothorax in non-neonates), 19 per 1000 (postoperative sepsis), and 38 per 1000 (pediatric heart surgery mortality), requiring patient volumes of 49 869, 419, and 201 to detect an event rate twice the statewide average; 0%, 6.6%, and 25%, respectively, of California hospitals had this pediatric volume.
Using these AHRQ-developed, nationally endorsed measures of the quality of inpatient pediatric care, one would not be able to identify many hospitals with performance 2 times worse than the statewide average due to extremely low event rates and inadequate pediatric hospital volume.
本研究旨在确定有足够样本量的医院比例，以便使用美国医疗保健研究与质量局（AHRQ）儿科质量指标（PDI）有意义地比较绩效，这些指标衡量儿科住院不良事件，如压疮发生率和因医疗导致的感染，已经得到全国认可，目前至少有 2 个州在公开报告。
我们对 2005 年至 2007 年加利福尼亚州年龄<18 岁的住院患者进行了医院层面的横断面分析。对于 9 项医院层面的 PDI，在排除 PDI 指示入院时存在的出院病例后，我们为每个 PDI 确定了每个指标在每个医院的合格儿科患者数量、全州平均率以及有足够数量的医院可以识别出不良事件率是全州平均率的两倍。
在研究期间（N=2333556 例出院），未经调整的加利福尼亚州 PDI 不良事件发生率为每 1000 例出院 0.2 至 38 例。特定措施的事件发生率例如，每 1000 例 0.2（非新生儿医源性气胸），19 每 1000 例（术后败血症）和 38 每 1000 例（儿科心脏手术死亡率），需要 49869、419 和 201 名患者才能检测到不良事件发生率是全州平均水平的两倍；分别有 0%、6.6%和 25%的加利福尼亚医院有这个儿科量。
使用这些 AHRQ 制定的、全国认可的住院儿科护理质量指标，如果由于极低的事件率和不足的儿科医院量，将无法识别出许多表现比全州平均水平差两倍的医院。
