Concordance Between Pediatric Safety Indicator Measure Sets Across a Sample of Pediatric Hospitals

Area of Science:

• Healthcare quality measurement
• Pediatric patient safety
• Performance ranking methodologies

Background:

• Hospital-acquired conditions (HAC) and Pediatric Quality Indicators (PDI) are key metrics for assessing pediatric hospital performance.
• Evaluating hospital performance rankings requires understanding the impact of different measure sets.

Purpose of the Study:

• To compare hospital performance rankings using the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions (HAC) Reduction Program and the Agency for Healthcare Research and Quality Pediatric Quality Indicators (PDI) measure sets.
• To determine if the choice of measure set significantly alters hospital performance evaluations in pediatric settings.

Main Methods:

• Retrospective cohort study utilizing inpatient data from 42 hospitals in the Pediatric Health Information System (PHIS) (2021-2022).
• Extracted and ranked hospitals on 8 HAC and 7 PDI measures.
• Calculated summary rankings using the geometric mean of ranks and assessed concordance between measure sets.

Main Results:

• A moderate-to-strong linear association was found between HAC and PDI rankings (r=0.63, P<0.001).
• Overall rankings showed no significant difference (median difference=-0.5, P=0.84) with moderate agreement in ranking quartiles (Klw=0.46).
• Significant ranking discrepancies (≥5 rank difference) were observed in 63% of hospitals, with only 5% ranked identically.

Conclusions:

• While overall performance rankings are broadly similar between HAC and PDI measure sets, substantial individual hospital ranking differences exist.
• Pediatric hospitals must carefully consider measure definitions and their applicability to specific patient populations when selecting performance evaluation sets.
• The choice of measure set can lead to vastly different performance perceptions for some hospitals, impacting quality improvement initiatives.