Recognizing Differences in Hospital Quality Performance for Pediatric Inpatient Care

Area of Science:

• Pediatric Healthcare Quality
• Health Services Research
• Biostatistics

Background:

• Public reporting of hospital quality measures aims to guide consumer choice and drive quality improvement.
• The adequacy of data for assessing pediatric inpatient care quality across hospitals and states is not well-established.

Purpose of the Study:

• To determine the number of hospitals and states with sufficient pediatric discharges to reliably detect worse-than-average inpatient care.
• To evaluate the statistical power of existing data for various pediatric quality measures.

Main Methods:

• Retrospective analysis of 2009 Kids' Inpatient Database (3974 hospitals, 44 states).
• Assessed 11 all-condition and condition-specific quality measures.
• Calculated the number of hospitals/states meeting an 80% power standard to detect 20% worse-than-average care over 3 years, approximating volume as 3x actual discharges.

Main Results:

• All states and most hospitals met the power standard for family experience-of-care and adverse drug events.
• For condition-specific measures (asthma, birth, mental health), 52%-90% of condition-specific discharges and 40-44 states met the standard.
• Few hospitals/states met the standard for sickle cell disease and other specific conditions (e.g., heart surgery, seizure).

Conclusions:

• Most children receive care in hospitals with adequate power for general quality measures.
• Data limitations hinder the reliable assessment of condition-specific pediatric inpatient quality.
• Policy incentives for pediatric quality should consider these data power disparities.