With no currently accepted benchmarks for what constitutes best in class performance for treating children with asthma, bronchiolitis, and pneumonia, researchers recently set out to determine achievable benchmarks of care for the clinical quality indicators that hospitals can target to measure the care they are delivering.
"Even for the most common pediatric conditions, in which there are clear evidence-based guidelines for care, there continues to be significant variability in how well hospitals follow these guidelines," Dr. Kavita Parikh of the Children’s National Medical Center and George Washington School of Medicine in Washington, and her associates, reported in an article scheduled to appear in the September issue of Pediatrics (2014;134:555-62). "We have demonstrated that administrative data can be used to calculate ABCs [achievable benchmarks of care] for the top three admission diagnoses in pediatric hospital care. These ABCs represent measurable and attainable goals for standardization of care, and they can be the starting point for individual hospitals to evaluate their performance to a national standard."
Administrative data from encounters at 42 hospitals during 2012, including 22,186 asthma, 14,882 bronchiolitis, and 12,983 pneumonia encounters were reviewed. The following achievable benchmarks of care were determined:
• For asthma in children 2-18 years: chest radiograph utilization of 24.5%; antibiotic administration, 6.6%; and ipratropium bromide use greater than 2 days, 0%;
• For bronchiolitis in children 2 months-2 years: chest radiograph utilization of 32.4%; viral testing, 0.6%; antibiotic administration, 18.5%; bronchodilator use greater than 2 days of 0%; and steroid use, 6.4%.
• For pneumonia in children 2 months-18 years: complete blood cell count utilization, 28.8%; viral testing, 1.5%; initial narrow-spectrum antibiotic use, 60.7%; erythrocyte sedimentation rate, 3.5%; and C-reactive protein, 0.1%.
The authors said the study had several limitations. The data was based on outcomes at tertiary care hospitals, so it may not be generalizable to the non–tertiary care hospital setting. The authors also were unable to determine if the utilization occurred in the emergency room or in the inpatient setting.
The authors had no financial disclosures.