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Small numbers limit the use of the inpatient pediatric quality indicators for hospital comparison

Naomi S Bardach1, Alyna T Chien, R Adams Dudley

  • 1Department of General Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, USA. bardachn@peds.ucsf.edu

Academic Pediatrics
|July 6, 2010
PubMed

Insights

Many hospitals lack sufficient pediatric patient volumes to reliably assess performance using Agency for Healthcare Research and Quality (AHRQ) pediatric quality indicators (PDIs). Low event rates further hinder meaningful comparisons of inpatient pediatric care quality.

Area of Science:

  • Healthcare Quality and Safety
  • Pediatric Health Outcomes
  • Health Services Research

Background:

  • The Agency for Healthcare Research and Quality (AHRQ) developed pediatric quality indicators (PDIs) to measure adverse events in pediatric inpatient care.
  • These PDIs are nationally endorsed and publicly reported in some states, aiming to improve healthcare quality.
  • Assessing hospital performance requires adequate sample sizes to ensure statistically meaningful comparisons.

Purpose of the Study:

  • To determine the percentage of hospitals with adequate sample sizes for meaningful performance comparisons using AHRQ PDIs.
  • To evaluate the feasibility of identifying hospitals with significantly worse performance based on current pediatric inpatient data.
  • To assess the impact of low event rates and hospital volume on the reliability of PDIs.

Main Methods:

  • A cross-sectional analysis of California hospital discharges for patients under 18 years from 2005-2007 was conducted.
  • For nine hospital-level PDIs, eligible pediatric patient volumes were calculated per hospital.
  • The percentage of hospitals meeting the volume threshold to detect an event rate twice the statewide mean was determined.

Main Results:

  • Nationwide event rates for PDIs ranged from 0.2 to 38 per 1000 discharges.
  • Detecting an event rate twice the statewide average required substantial patient volumes (e.g., 49,869 for iatrogenic pneumothorax).
  • A significant proportion of California hospitals (0% to 25%) had inadequate pediatric volumes for specific PDIs.

Conclusions:

  • Many hospitals have insufficient pediatric patient volumes to reliably use AHRQ PDIs for performance comparison.
  • Extremely low event rates and inadequate hospital volumes limit the ability to identify hospitals with significantly worse performance.
  • Current PDIs may not be effective for identifying performance disparities in pediatric inpatient care due to data limitations.
Abstract

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