Identifying Hospitals With High Performance in Pediatric Safety for All Children

Area of Science:

• Healthcare Quality Improvement
• Patient Safety Research
• Health Equity Studies

Background:

• Adverse safety events significantly contribute to patient morbidity and mortality.
• The Agency for Healthcare Research and Quality (AHRQ) developed seven pediatric-specific quality indicators (PDIs) to assess severe, preventable adverse outcomes.
• Previous research indicated disproportionate impacts of PDI safety events on Black and Hispanic pediatric patients, with significant inter-hospital variation.

Purpose of the Study:

• To adapt Centers for Medicare and Medicaid Services (CMS) methods for identifying hospitals that demonstrate excellence in pediatric safety equity.
• To define pediatric safety equity as achieving both high overall patient safety and minimal racial/ethnic disparities.
• To lay the groundwork for future investigations into best practices at high-performing hospitals for advancing pediatric safety equity.

Main Methods:

• Utilized positive deviance methods, which focus on studying high-performing entities to uncover successful strategies.
• Adapted methodologies previously employed by the Centers for Medicare and Medicaid Services (CMS).
• Focused on identifying hospitals that excel in both overall pediatric safety and the reduction of disparities in safety events.

Main Results:

• The study successfully adapted CMS methods to identify hospitals excelling in pediatric safety equity.
• Established a framework for defining and measuring pediatric safety equity, combining overall safety performance with disparity reduction.
• Highlighted the potential for positive deviance approaches in understanding and addressing health disparities in pediatric care.

Conclusions:

• Pediatric safety equity can be defined and measured by assessing both high overall safety and low disparities.
• Identifying and studying high-performing hospitals offers a promising avenue for discovering interventions to improve pediatric patient safety broadly.
• Future research should focus on exploring the specific practices of these high-performing hospitals to advance health equity in pediatric safety.