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Development and Testing of the Pediatric Respiratory Illness Measurement System (PRIMES) Quality Indicators
Rita Mangione-Smith1,2, Carol P Roth3, Maria T Britto4,5
1Seattle Children Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington; rita.mangione-smith@seattlechildrens.org.
Insights
New quality indicators for pediatric respiratory illnesses, PRIMES, show significant variations in hospital care. This system helps assess and improve treatment for conditions like asthma and pneumonia in children.
Area of Science:
- Pediatric healthcare quality assessment.
- Development and validation of clinical quality measures.
- Respiratory illness management in children.
Background:
- Assessing the quality of care for common pediatric respiratory illnesses in hospitals is crucial.
- Existing quality measures may not adequately capture variations in care for conditions like asthma, bronchiolitis, croup, and community-acquired pneumonia (CAP).
Purpose of the Study:
- To develop and test a new set of evidence-based quality indicators for pediatric hospital care of common respiratory illnesses.
- To evaluate the feasibility and sensitivity of these measures to variations in care.
Main Methods:
- Development of the Pediatric Respiratory Illness Measurement System (PRIMES) using expert panel-endorsed, evidence-based indicators.
- Testing PRIMES across three tertiary care children's hospitals using data from 2796 children with asthma, bronchiolitis, croup, or CAP.
- Medical record abstraction and calculation of quality scores (0-100 scale) to assess within- and between-hospital variations.
Main Results:
- Condition-level PRIMES scores for CAP and croup showed significant differences between hospitals (P < .001).
- Asthma and bronchiolitis scores revealed significant within-hospital variations, with emergency department care scoring higher than inpatient care.
- Significant variations in quality scores were observed across different conditions and care settings.
Conclusions:
- The Pediatric Respiratory Illness Measurement System (PRIMES) provides a validated set of measures for assessing hospital-based care quality for common pediatric respiratory conditions.
- PRIMES demonstrates sensitivity to variations in care, highlighting areas for potential quality improvement in pediatric respiratory illness management.
- This system offers a valuable tool for hospitals to monitor and enhance the quality of care delivered to children with respiratory illnesses.
Objectives:
To develop and test quality indicators for assessing care in pediatric hospital settings for common respiratory illnesses.
Patients:
A sample of 2796 children discharged from the emergency department or inpatient setting at 1 of the 3 participating hospitals with a primary diagnosis of asthma, bronchiolitis, croup, or community-acquired pneumonia (CAP) between January 1, 2010, and December 31, 2011.
Setting:
Three tertiary care children's hospitals in the United States.
Methods:
We developed evidence-based quality indicators for asthma, bronchiolitis, croup, and CAP. Expert panel-endorsed indicators were included in the Pediatric Respiratory Illness Measurement System (PRIMES). This new set of pediatric quality measures was tested to assess feasibility of implementation and sensitivity to variations in care. Medical records data were extracted by trained abstractors. Quality measure scores (0-100 scale) were calculated by dividing the number of times indicated care was received by the number of eligible cases. Score differences within and between hospitals were determined by using the Student's t-test or analysis of variance.
Results:
CAP and croup condition-level PRIMES scores demonstrated significant between-hospital variations (P < .001). Asthma and bronchiolitis condition-level PRIMES scores demonstrated significant within-hospital variation with emergency department scores (means [SD] 82.2(6.1)-100.0 (14.4)] exceeding inpatient scores (means [SD] 71.1 (2.0)-90.8 (1.3); P < .001).
Conclusions:
PRIMES is a new set of measures available for assessing the quality of hospital-based care for common pediatric respiratory illnesses.
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