Development of the Children with Disabilities Algorithm
September 28, 2015; Pediatrics
Alyna T. Chien, MD, MS and the Children with Disabilities Algorithm (CWDA) team conducted a cross-sectional study that (1) ensured each of the 14,567 codes within the 2012 ICD-9-CM codebook was independently classified by 3 to 9 pediatricians based on the code’s likelihood of indicating CWD and (2) triangulated the resulting CWDA against parent and physician assessment of children’s disability status by using survey and chart
Unmet Health Care Need in US Adolescents and Adult Health Outcomes
August 17, 2015; Pediatrics
Dougal S. Hargreaves, MBBChir, MD, (Res) and the Adolescent Assessment of Preparation for Transition (ADAPT) Survey team used nationally representative data from 14,800 subjects who participated in Wave I and Wave IV of the National Longitudinal Study of Adolescent to Adult Health. Logistic regression models were used to estimate the association between unmet health care need in adolescence and 5 self-reported measures of adult health. They found that unmet health care need was reported by 19.2% of adolescents and predicted worse adult health.
Same-Hospital Readmission Rates as a Measure of Pediatric Quality of Care
August 3, 2015; JAMA Pediatrics
Alisa Khan, MD, MPH and the Pediatric Readmission Measures team analyzed all-payer inpatient claims for 701,263 pediatric discharges (patients aged 0-17 years) from 177 acute care hospitals in New York State from January 1, 2005, through November 30, 2009, to identify 30-day same-hospital readmissions (SHRs), different-hospital readmissions (DHRs), and all-hospital readmissions (AHRs). They found that different-hospital readmissions differentially affect hospitals’ pediatric readmission rates and anticipated performance, making SHRs an incomplete surrogate for AHRs—particularly for certain hospital types.
The Development of a Pediatric Inpatient Experience of Care Measure: Child HCAHPS®
July 20, 2015; Pediatrics
The Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality commissioned the development of a pediatric version of the Adult Hospital Consumer Assessment of Healthcare Providers and Systems Survey (Adult HCAHPS®). Child HCAHPS, the pediatric version, is a survey of parents/guardians of pediatric patients who were recently hospitalized. Sara L. Toomey, MD, MPhil, MPH, MSc and the Child HCAHPS team describe the development of Child HCAHPS, which included an extensive review of the literature and quality measures, expert interviews, focus groups, cognitive testing, pilot testing of the draft survey, a national field test, psychometric analysis, and end-user testing of the final survey.
Pediatric Clinicians and Parents: Working Together for the Benefit of the Child
July 16, 2015; Academic Pediatrics
CEPQM director Mark Schuster, MD, PhD spoke about clinician communication with families as the topic for the Academic Pediatric Association Presidential Address in April 2015. He advocates for pediatric clinicians to do all they can for parents in order to provide the best care for children.
Recognizing Differences in Pediatric Hospital Quality
June 13, 2015; Pediatrics
Jay G. Berry, MD, MPH and the Pediatric Readmission Measures team conducted a retrospective analysis of hospital discharges for children aged 0 to 17 years from 3974 hospitals in 44 states. For 11 measures of all-condition or condition-specific quality, they assessed the number of hospitals and states that met a “power standard” of 80% power for a 5% level significance test to detect when care is 20% worse than average over a 3-year period. The team found that most children are admitted to hospitals in which all-condition measures of quality have adequate power to show modest differences in performance from average, but most condition-specific measures do not.
A Trigger Tool to Detect Harm in Pediatric Inpatient Settings
May 18, 2015; Pediatrics
The Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool team collaborated with Children's Hospital Association (CHA) on their effort to develop a trigger tool. They reviewed 600 patient charts and found 240 harmful events (“harms”), resulting in a rate of 40 harms per 100 patients admitted and 54.9 harms per 1000 patient days across the 6 hospitals.
Measuring Quality of Pediatric Care: Where We’ve Been and Where We’re Going
March 16, 2015;
When CEPQM director Mark Schuster, MD, PhD won the Douglas K. Richardson Award for Perinatal and Pediatric Healthcare Research in 2014, he gave a speech about quality measurement. Dr. Schuster starts by discussing why we measure quality and then describes where the field was 2 decades ago when he first started working it. He then talks about where we are now and where he hopes to see us go in the future.
Measuring Pediatric Hospital Readmission Rates to Drive Quality Improvement
Mari Nakamura, MD, MPH and the Pediatric Readmission Measures team sought to describe the importance of readmissions in children and the challenges of developing readmission quality measures. They consider findings and perspectives from research studies and commentaries in the pediatric and adult literature, characterizing arguments for and against using readmission rates as measures of pediatric quality and discussing available evidence and knowledge gaps.
Implementing national benchmarks for pediatric care quality
March 26, 2014;
Boston Children's Hospital's Clinical Health Blog interviewed CEPQM director Mark Schuster, MD, PhD and managing director Sara Toomey, MD, MPH about the Consumer Assessment of Healthcare Providers and Systems Hospital Survey - Child Version (Child HCAHPS) and how it fits into the overall scheme of pediatric care quality improvement. This interview was also published in the the hospital's newsletter Pediatric Dose.
Rehospitalization for Childhood Asthma: Timing, Variation, and Opportunities for Intervention
The Journal of Pediatrics
Chén C. Kenyon, MD and the Pediatric Readmission Measures team sought to assess the timing of pediatric asthma rehospitalization, variation in rate of rehospitalization across hospitals, and factors associated with rehospitalization at different intervals. They found that significant variation in asthma rehospitalization rates exists across children’s hospitals from 7 to 365 days after an index admission. Racial/ethnic and economic disparities emerge at 60 days. By 1 year, rehospitalizations account for 1 in 6 hospitalizations.
Pediatric Readmission Prevalence and Variability Across Hospitals
The Journal of the American Medical Association
Jay G. Berry, MD, MPH and the Pediatric Readmission Measures team analyzed 568,845 admissions at 72 children's hospitals between July 1, 2009, and June 30, 2010, in the National Association of Children's Hospitals and Related Institutions Case Mix Comparative data set. They found that the 30-day unadjusted readmission rate for all hospitalized children was 6.5% (n = 36 734).
Please contact us with questions and comments at CEPQM@childrens.harvard.edu.