Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, Bologna 40126, Italy.
Ital J Pediatr. 2014 Jan 21;40:7. doi: 10.1186/1824-7288-40-7.
Quality assessment in pediatric care has recently gained momentum. Although many of the approaches to indicator development are similar regardless of the population of interest, few nationwide sets of indicators specifically designed for assessment of primary care of children exist. We performed an empirical analysis of the validity of "Pediatric Asthma Hospitalization Rate" indicator under the assumption that lower admission rates are associated with better performance of primary health care.
The validity of "Pediatric Asthma Hospitalization Rate" indicator proposed by the Agency for Healthcare Research and Quality in the Italian context was investigated with a focus on selection of diagnostic codes, hospitalization type, and risk adjustment. Seasonality and regional variability of hospitalization rates for asthma were analyzed for Italian children aged 2-17 years discharged between January 1, 2009, and December 31, 2011 using the hospital discharge records database. Specific rates were computed for age classes: 2-4, 5-9, 10-14, 15-17 years.
In the years 2009-2011 the number of pediatric hospitalizations for asthma was 14,389 (average annual rate: 0.52 per 1,000) with a large variability across regions. In children aged 2-4 years, the risk of hospitalization for asthma was 14 times higher than in adolescents, then it dropped to 4 in 5- to 9-year-olds and to 1.1 in 10- to 14-year-olds. The inclusion of diagnoses of bronchitis revealed that asthma and bronchitis are equally represented as causes of hospital admissions and have a similar seasonality in preschool children, while older age groups experience hospital admissions mainly in spring and fall, this pattern being consistent with a diagnosis of atopic asthma. Rates of day hospital admissions for asthma were up to 5 times higher than the national average in Liguria and some Southern regions, and close to zero in some Northern regions.
The patterns of hospitalization for pediatric asthma in Italy showed that at least two different indicators are needed to measure accurately the quality of care provided to children. The candidate indicators should also include day hospital admissions to better assess accessibility. Future evaluation by a structured clinical panel review at the national level might be helpful to refine indicator definitions and risk groupings, to determine appropriate application for such measures, and to make recommendations to policy makers.
儿科保健质量评估最近得到了重视。尽管无论关注人群如何，许多指标的制定方法都相似，但专门用于评估儿童初级保健的全国性指标集却很少。我们根据“儿科哮喘住院率”指标可以假设较低的入院率与初级卫生保健表现更好的假设，对其进行了实证分析。
在意大利背景下，对医疗保健研究与质量局提出的“儿科哮喘住院率”指标的有效性进行了研究，重点是诊断代码的选择、住院类型和风险调整。利用 2009 年 1 月 1 日至 2011 年 12 月 31 日期间出院的 2-17 岁意大利儿童的住院记录数据库，分析了意大利儿童哮喘住院率的季节性和地域差异。针对年龄组：2-4 岁、5-9 岁、10-14 岁、15-17 岁，计算了特定的发病率。
在 2009-2011 年，儿童哮喘住院人数为 14389 人（平均年发病率为每 1000 人 0.52 人），各地区差异很大。2-4 岁儿童哮喘住院风险是青少年的 14 倍，5-9 岁儿童为 4 倍，10-14 岁儿童为 1.1 倍。纳入支气管炎诊断后发现，哮喘和支气管炎是住院的同等原因，且学龄前儿童的季节性相同，而年龄较大的儿童主要在春季和秋季住院，这种模式与特应性哮喘的诊断一致。哮喘日间住院的比例在利古里亚和一些南部地区高达全国平均水平的 5 倍，而在一些北部地区则接近零。
意大利儿科哮喘住院模式表明，至少需要两个不同的指标来准确衡量为儿童提供的护理质量。候选指标还应包括日间住院，以更好地评估可及性。未来在国家层面进行结构化临床小组审查可能有助于完善指标定义和风险分组，确定此类措施的适当应用，并向决策者提出建议。
