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Choosing Wisely Campaign: Report Card and Achievable Benchmarks of Care for Children's Hospitals
Mario Reyes1,2, Evan Paulus3, Carla Hronek4
1Nicklaus Children's Hospital, Miami, Florida; mario.reyes@mch.com.
Insights
A new report card assessing hospital performance on pediatric Choosing Wisely Campaign recommendations reveals significant variations in care. Hospitals show gaps in adhering to achievable benchmarks, highlighting areas for quality improvement in pediatric medicine.
Area of Science:
- Pediatric Hospital Medicine
- Healthcare Quality Improvement
- Clinical Practice Guidelines
Background:
- The Society of Hospital Medicine (SHM) issued 5 pediatric recommendations for the Choosing Wisely Campaign (CWC) in 2013.
- Assessing adherence to these evidence-based guidelines is crucial for optimizing pediatric care.
Purpose of the Study:
- To develop a quality report card based on SHM-CWC pediatric recommendations.
- To establish achievable benchmarks of care (ABCs) for key quality metrics.
- To analyze hospital performance against these benchmarks within the Pediatric Health Information System (PHIS).
Main Methods:
- A retrospective study of children hospitalized between January 2013 and September 2015 across 32 PHIS hospitals.
- Quality metrics included chest radiograph (CXR) use in asthma and bronchiolitis, bronchodilator use in bronchiolitis, systemic corticosteroids for lower respiratory tract infections (LRTI), and acid suppression for gastroesophageal reflux (GER).
- Achievable benchmarks of care (ABCs) were calculated for each metric.
Main Results:
- Calculated ABCs: CXR in asthma (22.3%), CXR in bronchiolitis (19.8%), bronchodilators in bronchiolitis (17.9%), systemic corticosteroids in LRTI (5.5%), and acid suppressors in GER (32.2%).
- Significant hospital variation observed in CXR for asthma and bronchiolitis, bronchodilators for bronchiolitis, and acid suppressors for GER.
- Less variation noted in the use of systemic corticosteroids for LRTI.
Conclusions:
- A novel report card and ABCs were developed for SHM-CWC pediatric recommendations.
- Substantial variance in clinical practices and performance gaps relative to ABCs were identified among hospitals.
- These findings provide a clear roadmap for targeted quality improvement initiatives in pediatric hospital care.
Objectives:
In 2013, the Society of Hospital Medicine (SHM) released 5 pediatric recommendations for the Choosing Wisely Campaign (CWC). Our goals were to develop a report card on the basis of those recommendations, calculate achievable benchmarks of care (ABCs), and analyze performance among hospitals participating in the Pediatric Health Information System.
Methods:
Children hospitalized between January 2013 and September 2015 from 32 Pediatric Health Information System hospitals were studied. The quality metrics in the report card included the use of chest radiograph (CXR) in asthma and bronchiolitis, bronchodilators in bronchiolitis, systemic corticosteroids in lower respiratory tract infections (LRTI), and acid suppression therapy in gastroesophageal reflux (GER). ABCs were calculated for each metric.
Results:
Calculated ABCs were 22.3% of patients with asthma and 19.8% of patients with bronchiolitis having a CXR, 17.9% of patients with bronchiolitis receiving bronchodilators, 5.5% of patients with LRTIs treated with systemic corticosteroids, and 32.2% of patients with GER treated with acid suppressors. We found variation among hospitals in the use of CXR in asthma (median: 34.7%, interquartile range [IQR]: 28.5%-45.9%), CXR in bronchiolitis (median: 34.4%, IQR: 27.9%-49%), bronchodilators in bronchiolitis (median: 55.4%, IQR: 32.3%-64.9%), and acid suppressors in GER (median: 59.4%, IQR: 49.9%-71.2%). Less variation was noted in the use of systemic corticosteroids in LRTIs (median: 13.5%, IQR: 11.1%-17.9%).
Conclusions:
A novel report card was developed on the basis of the SHM-CWC pediatric recommendations, including ABCs. We found variance in practices among institutions and gaps between hospital performances and ABCs. These findings represent a roadmap for improvement.
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