Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington;
Department of Pediatrics, University of Washington, Seattle, Washington.
Pediatrics. 2019 Aug;144(2). doi: 10.1542/peds.2019-0242.
The Pediatric Respiratory Illness Measurement System (PRIMES) generates condition-specific composite quality scores for asthma, bronchiolitis, croup, and pneumonia in hospital-based settings. We sought to determine if higher PRIMES composite scores are associated with improved health-related quality of life, decreased length of stay (LOS), and decreased reuse.
We conducted a prospective cohort study of 2334 children in 5 children's hospitals between July 2014 and June 2016. Surveys administered on admission and 2 to 6 weeks postdischarge assessed the Pediatric Quality of Life Inventory (PedsQL). Using medical records data, 3 PRIMES scores were calculated (0-100 scale; higher scores = improved adherence) for each condition: an overall composite (including all quality indicators for the condition), an overuse composite (including only indicators for care that should not be provided [eg, chest radiographs for bronchiolitis]), and an underuse composite (including only indicators for care that should be provided [eg, dexamethasone for croup]). Multivariable models assessed relationships between PRIMES composite scores and (1) PedsQL improvement, (2) LOS, and (3) 30-day reuse.
For every 10-point increase in PRIMES overuse composite scores, LOS decreased by 8.8 hours (95% confidence interval [CI] -11.6 to -6.1) for bronchiolitis, 3.1 hours (95% CI -5.5 to -1.0) for asthma, and 2.0 hours (95% CI -3.9 to -0.1) for croup. Bronchiolitis overall composite scores were also associated with shorter LOS. PRIMES composites were not associated with PedsQL improvement or reuse.
Better performance on some PRIMES condition-specific composite measures is associated with decreased LOS, with scores on overuse quality indicators being a primary driver of this relationship.
儿科呼吸疾病测量系统（PRIMES）可针对医院环境中的哮喘、细支气管炎、哮吼和肺炎生成特定病症的综合质量评分。我们试图确定更高的 PRIMES 综合评分是否与改善健康相关的生活质量、减少住院时间（LOS）和减少再入院率相关。
我们对 2014 年 7 月至 2016 年 6 月期间 5 家儿童医院的 2334 名儿童进行了前瞻性队列研究。入院时和出院后 2 至 6 周进行的调查评估了儿科生活质量量表（PedsQL）。使用病历数据，为每个病症计算了 3 个 PRIMES 评分（0-100 分；得分越高表示依从性越好）：一个总体综合评分（包括病症的所有质量指标）、过度使用综合评分（仅包括不应该提供的治疗指标，例如细支气管炎的胸部 X 光片）和不足使用综合评分（仅包括应该提供的治疗指标，例如哮吼的地塞米松）。多变量模型评估了 PRIMES 综合评分与（1）PedsQL 改善、（2）LOS 和（3）30 天再入院率之间的关系。
对于每个 10 分的 PRIMES 过度使用综合评分增加，细支气管炎的 LOS 减少 8.8 小时（95%置信区间 [CI] -11.6 至 -6.1），哮喘减少 3.1 小时（95% CI -5.5 至 -1.0），哮吼减少 2.0 小时（95% CI -3.9 至 -0.1）。细支气管炎的总体综合评分也与 LOS 较短有关。PRIMES 综合评分与 PedsQL 改善或再入院率无关。
在某些特定病症的 PRIMES 综合测量指标上表现更好与 LOS 减少相关，过度使用质量指标的得分是这种关系的主要驱动因素。
