建立儿童哮喘、细支气管炎和肺炎住院治疗的基准。

Establishing benchmarks for the hospitalized care of children with asthma, bronchiolitis, and pneumonia.

机构信息

Children's National Medical Center and George Washington School of Medicine, Washington, District of Columbia;

Children's Hospital Association, Overland Park, Kansas;

出版信息

Pediatrics. 2014 Sep;134(3):555-62. doi: 10.1542/peds.2014-1052.

DOI:10.1542/peds.2014-1052

PMID:25136044

Abstract

BACKGROUND AND OBJECTIVES

Asthma, pneumonia, and bronchiolitis are the leading causes of admission for pediatric patients; however, the lack of accepted benchmarks is a barrier to quality improvement efforts. Using data from children hospitalized with asthma, bronchiolitis, or pneumonia, the goals of this study were to: (1) measure the 2012 performance of freestanding children's hospitals using clinical quality indicators; and (2) construct achievable benchmarks of care (ABCs) for the clinical quality indicators.

METHODS

This study was a cross-sectional trial using the Pediatric Health Information System database. Patient inclusions varied according to diagnosis: asthma (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 493.0-493.92) from 2 to 18 years of age; bronchiolitis (ICD-9-CM codes 466.11 and 466.19) from 2 months to 2 years of age; and pneumonia (ICD-9-CM codes 480-486, 487.0) from 2 months to 18 years of age. ABC methods use the best-performing hospitals that comprise at least 10% of the total population to compute the benchmark.

RESULTS

Encounters from 42 hospitals included: asthma, 22186; bronchiolitis, 14882; and pneumonia, 12983. Asthma ABCs include: chest radiograph utilization, 24.5%; antibiotic administration, 6.6%; and ipratropium bromide use >2 days, 0%. Bronchiolitis ABCs include: chest radiograph utilization, 32.4%; viral testing, 0.6%; antibiotic administration, 18.5%; bronchodilator use >2 days, 11.4%; and steroid use, 6.4%. Pneumonia ABCs include: complete blood cell count utilization, 28.8%; viral testing, 1.5%; initial narrow-spectrum antibiotic use, 60.7%; erythrocyte sedimentation rate, 3.5%; and C-reactive protein, 0.1%.

CONCLUSIONS

We report achievable benchmarks for inpatient care for asthma, bronchiolitis, and pneumonia. The establishment of national benchmarks will drive improvement at individual hospitals.

摘要

背景与目的

哮喘、肺炎和细支气管炎是导致儿科患者住院的主要原因；然而，缺乏公认的基准是质量改进工作的障碍。本研究使用因哮喘、细支气管炎或肺炎住院的儿童数据，旨在：（1）使用临床质量指标衡量独立儿童医院 2012 年的表现；（2）为临床质量指标构建可实现的护理基准（ABC）。

方法

本研究采用儿科健康信息系统数据库进行横断面试验。根据诊断，患者纳入情况有所不同：哮喘（国际疾病分类，第九修订版，临床修正[ICD-9-CM]代码 493.0-493.92）年龄为 2 至 18 岁；细支气管炎（ICD-9-CM 代码 466.11 和 466.19）年龄为 2 个月至 2 岁；肺炎（ICD-9-CM 代码 480-486、487.0）年龄为 2 个月至 18 岁。ABC 方法使用至少占总人群 10%的表现最佳的医院来计算基准。

结果

来自 42 家医院的就诊记录包括：哮喘 22186 例；细支气管炎 14882 例；肺炎 12983 例。哮喘 ABC 包括：胸部 X 光利用率 24.5%；抗生素使用率 6.6%；异丙托溴铵使用超过 2 天，0%。细支气管炎 ABC 包括：胸部 X 光利用率 32.4%；病毒检测 0.6%；抗生素使用率 18.5%；支气管扩张剂使用超过 2 天，11.4%；和皮质类固醇使用率 6.4%。肺炎 ABC 包括：全血细胞计数利用率 28.8%；病毒检测 1.5%；初始窄谱抗生素使用 60.7%；红细胞沉降率 3.5%；C 反应蛋白 0.1%。