Toomey Sara L, Elliott Marc N, Zaslavsky Alan M, Klein David J, Ndon Sifon, Hardy Shannon, Wu Melody, Schuster Mark A
Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts;
Pediatrics, Harvard Medical School, Boston, Massachusetts; and.
Pediatrics. 2017 Apr;139(4). doi: 10.1542/peds.2016-3372. Epub 2017 Mar 22.
Making national comparisons of family experience of inpatient pediatric care has been limited by the lack of a publicly available survey. The Agency for Healthcare Research and Quality and Centers for Medicare & Medicaid Services commissioned development of the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey to address this gap. Using Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey, we measured performance of hospitals in a national field test.
We analyzed 17 727 surveys completed from December 2012 to February 2014 by parents of children (<18 years) hospitalized at 69 hospitals in 34 states. For each of 18 survey measures, we calculated a case-mix-adjusted hospital "top-box" score (ie, percentage of respondents selecting the most positive response option). We quantified variation across hospitals by estimating hospital-level SDs for each item with a hierarchical linear probability model. We examined associations of family experience with patient, parent, and hospital characteristics. We compared aggregate performance on each measure across participating hospitals.
Mean hospital top-box scores ranged from 55% ("Preventing mistakes and helping you report concerns") to 84% ("Keeping you informed about your child's care in the emergency department"). The mean for overall rating of hospital stay was 73% (SD 7%). "Quietness of hospital room" scores varied most across hospitals (SD 8%). Overall top-box scores were higher for freestanding children's hospitals (74%) and children's hospitals within a hospital (73%) than for pediatric wards within hospitals (68%, = .007).
Family experience of pediatric inpatient care shows substantial room for improvement and varies considerably across hospitals and measures.
由于缺乏公开可用的调查，对儿科住院护理的家庭体验进行全国性比较受到限制。医疗保健研究与质量局以及医疗保险和医疗补助服务中心委托开展了儿童医院医疗服务提供者及系统消费者评估调查，以填补这一空白。我们利用该调查在全国范围的测试中衡量了医院的表现。
我们分析了2012年12月至2014年2月期间，34个州69家医院中18岁以下住院儿童的家长完成的17727份调查问卷。对于18项调查指标中的每一项，我们计算了病例组合调整后的医院“顶级评分”（即选择最积极回答选项的受访者百分比）。我们使用分层线性概率模型估计每个项目的医院层面标准差，以量化医院之间的差异。我们研究了家庭体验与患者、家长和医院特征之间的关联。我们比较了参与调查的医院在各项指标上的总体表现。
医院顶级评分的平均值范围从55%（“防止错误并帮助您报告问题”）到84%（“让您了解孩子在急诊科的护理情况”）。住院总体评价的平均值为73%（标准差7%）。“病房安静程度”得分在各医院之间差异最大（标准差8%）。独立儿童医院（74%）和医院内的儿童医院（73%）的总体顶级评分高于医院内的儿科病房（68%，P = 0.007）。
儿科住院护理的家庭体验有很大的改进空间，并且在不同医院和指标之间存在很大差异。
