Categorization of National Pediatric Quality Measures

House, Samantha A.; Coon, Eric R.; Schroeder, Alan R.; Ralston, Shawn L.

doi:10.1542/peds.2016-3269

Cited by 27 publications

(24 citation statements)

References 38 publications

(37 reference statements)

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“…The momentum for the pediatric studies on readmissions has been driven predominantly by the concern regarding the loss of reimbursement for "preventable" readmissions as is happening with adult hospitals and the use of readmission rates as a measure of quality of care in most pediatric organizations. 18 The purpose of our study was to assess the relationship between malnutrition in the general pediatric inpatient population and unplanned 7-day readmissions in a retrospective study with a large sample at a children' s hospital. Several medical conditions may covary with malnutrition.…”

mentioning

confidence: 99%

The Effect of Malnutrition on the Risk of Unplanned 7-Day Readmission in Pediatrics

Ehwerhemuepha

Bendig

Steele

et al. 2018

Hospital Pediatrics

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mentioning

confidence: 99%

The Effect of Malnutrition on the Risk of Unplanned 7-Day Readmission in Pediatrics

Ehwerhemuepha

Bendig

Steele

et al. 2018

Hospital Pediatrics

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“…As an example, .75% of the currently used quality process measures in pediatrics are used to target the underuse of health care services, such as documenting hydration status in gastroenteritis, obtaining a blood culture in patients with community-acquired pneumonia, and performing hearing testing for patients with otitis media with effusion. 4 The implementation of overuse measures, such as the administration of albuterol and/or steroids in bronchiolitis and appropriate testing for children with pharyngitis, is more challenging than that of underuse measures. Improving the adoption of a recommended test or intervention may be easier to conceptualize, accept, and measure.…”

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confidence: 99%

A (Not So) Perfectly Designed System: The Paradox of Medical Stewardship and Quality Measurement

Marin

Quiñonez

2019

Hospital Pediatrics

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Every system is perfectly designed to get the results it gets." 1 Health care quality measurement has become important for evaluating hospitals, practices, and individual clinicians. Unfortunately, our current quality measurement system is designed to reward those who do more even when doing more may not benefit, and may even harm, patients. Today, medical care is scrutinized through the lens of quality improvement and measurement, with patient experience being a key component of health care assessment. With medical overuse being described as a serious and extensive quality problem in US health care, 2 the current system will need to be redesigned for clinicians to effectively minimize unnecessary testing and treatments and, in short, champion medical stewardship. Despite efforts of campaigns and the dissemination of evidence-based guidelines to reduce the wasteful and unsustainable use of medical resources, pediatric patients continue to receive low-value care. 3 Here, we propose that 2 of the main vehicles for quality measurement do not currently align well with the intent of medical stewardship: quality measures and patient satisfaction scores. THE LACK OF OVERUSE QUALITY MEASURESPresent-day measures tend to favor assessments of underuse rather than overuse. As an example, .75% of the currently used quality process measures in pediatrics are used to target the underuse of health care services, such as documenting hydration status in gastroenteritis, obtaining a blood culture in patients with community-acquired pneumonia, and performing hearing testing for patients with otitis media with effusion. 4 The implementation of overuse measures, such as the administration of albuterol and/or steroids in bronchiolitis and appropriate testing for children with pharyngitis, is more challenging than that of underuse measures. Improving the adoption of a recommended test or intervention may be easier to conceptualize, accept, and measure. Deimplementation, or forgoing a test or intervention that evidence suggests should not happen, is more difficult to achieve. 5 When a patient receives a low-value test, even 1 that ultimately results in downstream harm, we do not typically view it as low-value care. In addition, many tests and interventions seen as the standard of care and subsequently proven to be of low value may be particularly challenging to deimplement. 6 For example, despite a randomized controlled trial from 2007 7 revealing no benefit of steroids for moderate-to-severe bronchiolitis, many young children continue to receive this therapy. 8

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“…A recent review of 15 national quality measure sets identified 257 unique measures to evaluate pediatric quality of care. 7 Of these, only one focused on mental health hospitalization. This measure, which was endorsed by the National Quality Forum, determines the percentage of discharges for patients six years of age and older who were hospitalized for mental health diagnoses and who had a follow-up visit with a mental health practitioner within seven and 30 days of hospital discharge.…”

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confidence: 99%

Healthcare Quality for Children and Adolescents with Suicidality Admitted to Acute Care Hospitals in the United States

Leyenaar

McLaren

2018

Journal of Hospital Medicine

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S uicide is the second most common cause of death among children, adolescents, and young adults in the United States. In 2016, over 6,000 children and youth 5 to 24 years of age succumbed to suicide, thus reflecting a mortality rate nearly three times higher than deaths from malignancies and 28 times higher than deaths from sepsis in this age group. 1 Suicidal ideation and suicide attempts are even more common, with 17% of high school students reporting seriously considering suicide and 8% reporting suicide attempts in the previous 12 months. 2 These tragic statistics are reflected in our health system use, emergency department (ED) utilization for suicide attempts and suicidal ideation is growing at a tremendous rate, and over 50% of the children seen in EDs are subsequently admitted to the hospital for ongoing care. 3,4 In this issue of Journal of Hospital Medicine, Doupnik and colleagues present an analysis of pediatric hospitalizations for suicide attempts and suicidal ideation at acute care hospitals contained within the 2013 and 2014 National Readmissions Dataset. 5 This dataset reflects a nationally representative sample of pediatric hospitalizations, weighted to allow for national estimates. Although their focus was on hospital readmission, their analysis yielded additional valuable data about suicide attempts and suicidal ideation in American youth. The investigators identified 181,575 pediatric acute care hospitalizations for suicide attempts and suicidal ideation over the two-year study period, accounting for 9.5% of all acute care hospitalizations among children and adolescents 6 to 17 years of age nationally. This number exceeds the biennial number of pediatric hospitalizations for cellulitis, dehydration, and urinary tract infections, all of which are generally considered the "bread and butter" of pediatric hospital medicine. 6 Doupnik and colleagues rightly pointed out that hospital readmission is not a nationally endorsed measure to evaluate the quality of pediatric mental health hospitalizations. At the same time, their work highlights that acute care hospitals need strategies to measure the quality of pediatric hospitalizations for suicide attempts and suicidal ideation. Beyond readmissions, how should the quality of these hospital stays be evaluated? A recent review of 15 national quality measure sets identified 257 unique measures to evaluate pediatric quality of care. 7 Of these, only one focused on mental health hospitalization. This measure, which was endorsed by the National Quality Forum, determines the percentage of discharges for patients six years of age and older who were hospitalized for mental health diagnoses and who had a follow-up visit with a mental health practitioner within seven and 30 days of hospital discharge. 8 Given Doupnik et al.'s finding that one-third of all 30-day hospital readmissions occurred within seven days of hospital discharge, early follow-up visits with mental health practitioners is arguably essential.Although evidence-based quality measures to evaluate ho...

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Categorization of National Pediatric Quality Measures

Abstract: Pediatric quality measures are predominated by process measures targeting underuse of health care services. The content represented among these measures is broad, although there remain important gaps.

Cited by 27 publications

References 38 publications

The Effect of Malnutrition on the Risk of Unplanned 7-Day Readmission in Pediatrics

The Effect of Malnutrition on the Risk of Unplanned 7-Day Readmission in Pediatrics

A (Not So) Perfectly Designed System: The Paradox of Medical Stewardship and Quality Measurement

Healthcare Quality for Children and Adolescents with Suicidality Admitted to Acute Care Hospitals in the United States

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