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PDI Measures Technical Report Measures of Pediatric Health Care Quality Based on Hospital Administrative Data: The Pediatric Quality Indicators Technical Report Prepared Based on Contributions by: Kathryn McDonald, Principal Investigator Patrick Romano, Co-Investigator Sheryl Davies, Project Manager/Senior Research Assistant Corinna Haberland, Pediatric Health Services Researcher Jeffrey Geppert, Lead Analyst Amy Ku, Analyst Kavita Choudhry, Research Assistant We gratefully acknowledge the assistance of our clinical panels, peer reviewers, AHRQ project officers and our Support for Quality Indicators colleagues. This work also builds on previous work by our team along with many other contributors to development of the AHRQ Quality Indicators. We thank our previous collaborators, whose names appear on previous technical reports. February 20, 2006 Updated September, 2006 Table of Contents 1 Orientation to the Report .........................................................................................1 2 Introduction..............................................................................................................2 2.1 Background........................................................................................................2 2.2 Pediatric Quality Indicator Development ..........................................................2 3 Methods....................................................................................................................5 3.1 General Approach to Pediatric Indicator Development.....................................5 3.1.1 Phase I versus Phase II.................................................................................... 5 3.1.2 Identification of Potential Indicators............................................................... 5 3.1.3 Literature Review............................................................................................ 9 3.2 Operationalization of Indicators ........................................................................9 3.3 Clinician Panel Review Methods.....................................................................10 3.3.1 Panel Selection.............................................................................................. 10 3.3.2 Panel Composition........................................................................................ 10 3.3.3 Initial Evaluation........................................................................................... 11 3.3.4 Conference Call ............................................................................................ 12 3.3.5 Final Evaluation............................................................................................ 12 3.3.6 Tabulation of Results .................................................................................... 13 3.4 Peer Review Methods ......................................................................................14 3.5 Empirical Methods...........................................................................................14 3.5.1 Purpose of Analyses...................................................................................... 14 3.5.2 Analysis Approach........................................................................................ 15 4 Results....................................................................................................................18 4.1 Summary of Results.........................................................................................18 4.2 Overall Results from Clinician Panel Review .................................................20 4.3 Overall Results from Peer Review...................................................................22 4.3.1 Expanded Data.............................................................................................. 23 4.3.2 Data Standards .............................................................................................. 23 4.3.3 Validity Testing ............................................................................................ 23 4.3.4 Reinforcement of Panel Commentary........................................................... 24 4.3.5 Additional Suggestions for Existing and Future Indicators.......................... 24 4.4 Detailed Results by Indicator: Indicators Recommended for Inclusion in Software Module .............................................................................................24 4.4.1 ACCIDENTAL PUNCTURE OR LACERATION (PSI) ............................ 26 4.4.2 DECUBITUS ULCER (PSI)......................................................................... 32 4.4.3 FOREIGN BODY LEFT IN DURING PROCEDURE (PSI) ...................... 38 4.4.4 IATROGENIC PNEUMOTHORAX (IN NEONATES AT RISK) (PSI).... 42 4.4.5 IATROGENIC PNEUMOTHORAX IN NON-NEONATES (PSI)............. 47 4.4.6 POSTOPERATIVE HEMORRHAGE AND HEMATOMA (PSI).............. 52 4.4.7 POSTOPERATIVE RESPIRATORY FAILURE (PSI)............................... 58 4.4.8 POSTOPERATIVE SEPSIS (PSI) ............................................................... 63 4.4.9 POSTOPERATIVE WOUND DEHISCENCE (PSI)................................... 70 4.4.10 SELECTED INFECTION DUE TO MEDICAL CARE (PSI)..................... 76 4.4.11 TRANSFUSION REACTION (PSI) ............................................................ 82 4.4.12 ASTHMA ADMISSION RATE (PQI)......................................................... 86 Measures of Pediatric Health Care Quality ii 4.4.13 DIABETES SHORT-TERM COMPLICATIONS ADMISSION RATE (PQI) ............................................................................................................. 90 4.4.14 GASTROENTERITIS ADMISSION RATE (PQI)...................................... 93 4.4.15 PERFORATED APPENDIX ADMISSION RATE (PQI) ........................... 96 4.4.16 URINARY TRACT INFECTION ADMISSION RATE (PQI) ................... 99 4.4.17 PEDIATRIC HEART SURGERY MORTALITY RATE (IQI) ................ 102 4.4.18 PEDIATRIC HEART SURGERY VOLUME RATE (IQI)....................... 105 4.5 Detailed Results by Indicator: Deferred Indicators .......................................108 4.5.1 POSTOPERATIVE PHYSIOLOGIC AND METABOLIC DERANGEMENT (PSI)............................................................................. 108 4.5.2 DEHYDRATION ADMISSION RATE (PQI)........................................... 112 4.5.3 BACTERIAL PNEUMONIA ADMISSION RATE (PQI) ........................ 115 4.5.4 CRANIOTOMY MORTALITY RATE (IQI) ............................................ 119 5 Conclusion ...........................................................................................................123 6 References............................................................................................................126 Index of Appendices Appendix A. Specifics of Literature Search Methods Appendix B. Clinician Review Panels Appendix C. Example Panel Instructions and Questionnaires Appendix D. Peer Reviewers Index of Tables Table 1 - Current AHRQ QIs not considered for inclusion in pediatric patients ............... 6 Table 2 - Organizations contacted for nominations of panelists and potential indicators (for Phase II) ....................................................................................................................... 6 Table 3 - Multi-specialty Panel Composition................................................................... 11 Table 4 - Criteria for Agreement Status............................................................................ 13 Table 5 - Definitions for Overall Appropriateness of Indicator for Internal QI ............... 14 Table 6 - Calculation of PedQI Age Categories ............................................................... 16 Table 7 - ICD-9-CM Diagnosis Codes for PedQI Birth Weight Categories .................... 16 Table 8 - AHA Service Types........................................................................................... 17 Table 9 - Indicators recommended for inclusion in the Pediatric Quality Indicator Set .. 19 Table 10 - Deferred Indicators: not currently recommended for inclusion ...................... 20 Measures of Pediatric Health Care Quality iii AHRQ Quality Indicators Web Site: http://www.qualityindicators.ahrq.gov/ 1 Orientation to the Report This report documents the work undertaken in Phase I of a two-phase process to develop the Pediatric Quality Indicators as part of the Agency for Healthcare Research and Quality (AHRQ) contract, “Support for Quality Indicators II” under subcontract with Battelle Memorial Institute by Stanford University and the University of California at Davis. This work was initiated in response to a charge to develop indicators of children’s health care utilizing inpatient administrative data. These indicators examine both the quality of inpatient care, as well as the quality of outpatient care that can be inferred from inpatient data, such as potentially preventable hospitalizations. The report contains three main sections: 1. The introduction section launches the actual technical report and provides background regarding pediatric indicator development and the current effort to develop an indicator set based on administrative data. 2. The methods section outlines the approach used to gather evidence to identify and evaluate potential patient safety indicators, including the literature review, empirical analyses, and clinician panel review, as well as the operationalization of indicators and evaluation of risk adjustment approaches. 3. The results section
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