Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. e416-e425 (doi:10.1542/peds.2007-2477)
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ARTICLE

Preliminary Assessment of Pediatric Health Care Quality and Patient Safety in the United States Using Readily Available Administrative Data

Kathryn M. McDonald, MMa, Sheryl M. Davies, MAa, Corinna A. Haberland, MD, MSa, Jeffrey J. Geppert, EdM, JDb, Amy Ku, MHSAa and Patrick S. Romano, MD, MPHc

a Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
b Centers for Public Health Research and Evaluation, Battelle Memorial Institute, Sacramento, California
c Departments of Pediatrics and Internal Medicine and Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, California

OBJECTIVES. With >6 million hospital stays, costing almost $50 billion annually, hospitalized children represent an important population for which most inpatient quality indicators are not applicable. Our aim was to develop indicators using inpatient administrative data to assess aspects of the quality of inpatient pediatric care and access to quality outpatient care.

METHODS. We adapted the Agency for Healthcare Research and Quality quality indicators, a publicly available set of measurement tools refined previously by our team, for a pediatric population. We systematically reviewed the literature for evidence regarding coding and construct validity specific to children. We then convened 4 expert panels to review and discuss the evidence and asked them to rate each indicator through a 2-stage modified Delphi process. From the 2000 and 2003 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Kids' Inpatient Database, we generated national estimates for provider level indicators and for area level indicators.

RESULTS. Panelists recommended 18 indicators for inclusion in the pediatric quality indicator set based on overall usefulness for quality improvement efforts. The indicators included 13 hospital-level indicators, including 11 based on complications, 1 based on mortality, and 1 based on volume, as well as 5 area-level potentially preventable hospitalization indicators. National rates for all 18 of the indicators varied minimally between years. Rates in high-risk strata are notably higher than in the overall groups: in 2003 the decubitus ulcer pediatric quality indicator rate was 3.12 per 1000, whereas patients with limited mobility experienced a rate of 22.83. Trends in rates by age varied across pediatric quality indicators: short-term complications of diabetes increased with age, whereas admissions for gastroenteritis decreased with age.

CONCLUSIONS. Tracking potentially preventable complications and hospitalizations has the potential to help prioritize quality improvement efforts at both local and national levels, although additional validation research is needed to confirm the accuracy of coding.

Key Words: adverse events • health services research • pediatric • quality improvement • quality of care

Abbreviations: NACHRI—National Association of Children's Hospitals and Related Institutions • AHRQ—Agency for Healthcare Research and Quality • QI—quality indicator • PSI—patient safety indicators • HCUP—Healthcare Cost and Utilization Project • PDI—pediatric quality indicator • ICD-9-CM—International Classification of Diseases, Ninth Revision, Clinical Modification • KID—Kids' Inpatient Database

Accepted Mar 28, 2008.


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