明智选择运动：儿童医院护理的成绩单及可实现的基准

Choosing Wisely Campaign: Report Card and Achievable Benchmarks of Care for Children's Hospitals.

作者信息

Reyes Mario, Paulus Evan, Hronek Carla, Etinger Veronica, Hall Matt, Vachani Joyee, Lusk Jennifer, Emerson Christopher, Huddleson Patty, Quinonez Ricardo A

机构信息

Nicklaus Children's Hospital, Miami, Florida;

Department of Pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.

出版信息

Hosp Pediatr. 2017 Nov;7(11):633-641. doi: 10.1542/hpeds.2017-0029.

DOI:10.1542/hpeds.2017-0029

PMID:29066468

Abstract

OBJECTIVES

In 2013, the Society of Hospital Medicine (SHM) released 5 pediatric recommendations for the Choosing Wisely Campaign (CWC). Our goals were to develop a report card on the basis of those recommendations, calculate achievable benchmarks of care (ABCs), and analyze performance among hospitals participating in the Pediatric Health Information System.

METHODS

Children hospitalized between January 2013 and September 2015 from 32 Pediatric Health Information System hospitals were studied. The quality metrics in the report card included the use of chest radiograph (CXR) in asthma and bronchiolitis, bronchodilators in bronchiolitis, systemic corticosteroids in lower respiratory tract infections (LRTI), and acid suppression therapy in gastroesophageal reflux (GER). ABCs were calculated for each metric.

RESULTS

Calculated ABCs were 22.3% of patients with asthma and 19.8% of patients with bronchiolitis having a CXR, 17.9% of patients with bronchiolitis receiving bronchodilators, 5.5% of patients with LRTIs treated with systemic corticosteroids, and 32.2% of patients with GER treated with acid suppressors. We found variation among hospitals in the use of CXR in asthma (median: 34.7%, interquartile range [IQR]: 28.5%-45.9%), CXR in bronchiolitis (median: 34.4%, IQR: 27.9%-49%), bronchodilators in bronchiolitis (median: 55.4%, IQR: 32.3%-64.9%), and acid suppressors in GER (median: 59.4%, IQR: 49.9%-71.2%). Less variation was noted in the use of systemic corticosteroids in LRTIs (median: 13.5%, IQR: 11.1%-17.9%).

CONCLUSIONS

A novel report card was developed on the basis of the SHM-CWC pediatric recommendations, including ABCs. We found variance in practices among institutions and gaps between hospital performances and ABCs. These findings represent a roadmap for improvement.

摘要

目的

2013年，医院医学协会（SHM）发布了5条针对明智选择运动（CWC）的儿科建议。我们的目标是基于这些建议制定一份成绩单，计算可实现的医疗基准（ABCs），并分析参与儿科健康信息系统的医院之间的表现。

方法

对2013年1月至2015年9月期间32家儿科健康信息系统医院收治的儿童进行研究。成绩单中的质量指标包括哮喘和细支气管炎中胸部X光片（CXR）的使用、细支气管炎中支气管扩张剂的使用、下呼吸道感染（LRTI）中全身用糖皮质激素的使用以及胃食管反流（GER）中抑酸治疗的使用。计算每个指标的ABCs。

结果

计算得出的ABCs为：哮喘患者中进行CXR检查的比例为22.3%，细支气管炎患者中进行CXR检查的比例为19.8%，细支气管炎患者中接受支气管扩张剂治疗的比例为17.9%，LRTI患者中接受全身用糖皮质激素治疗的比例为5.5%，GER患者中接受抑酸治疗的比例为32.2%。我们发现各医院在哮喘中CXR的使用（中位数：34.7%，四分位间距[IQR]：28.5%-45.9%）、细支气管炎中CXR的使用（中位数：34.4%，IQR：27.9%-49%）、细支气管炎中支气管扩张剂的使用（中位数：55.4%，IQR：32.3%-64.9%）以及GER中抑酸剂的使用（中位数：59.4%，IQR：49.9%-71.2%）方面存在差异。LRTI中全身用糖皮质激素的使用差异较小（中位数：13.5%，IQR：11.1%-17.9%）。