Center of Excellence for Pediatric Quality Measurement | News & Publications

Factors Associated with Family Experience in Pediatric Inpatient Care

February 2020; Pediatrics
Jeremy Feng and the Child HCAHPS team conducted a cross-sectional study of 17,727 surveys completed from November 2012 to January 2014 by parents of children hospitalized at 69 hospitals in 34 states using the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey. Their analysis revealed that child comfort (aOR 1.50; 95 percent confidence interval 1.41–1.60) and nurse-parent communication (aOR 1.50; 95 percent confidence interval 1.42–1.58) showed the strongest relationships with willingness to recommend, followed by preparing to leave the hospital, doctor-parent communication, and keeping parents informed.

Improving Response Rates and Representation of Hard-to-Reach Groups in Family Experience Surveys

May 2019; Academic Pediatrics
Sara Toomey and the CEPQM team conducted a quasi-experimental study of parents of patients discharged from four units of a children's hospital. Parents were assigned to receive the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) via an audio-enabled tablet before discharge or via mail at approximately one week postdischarge. Response rates, child/respondent characteristics, and mean top-box scores between tablet and mail-only arms were compared. They found that administering Child HCAHPS on a tablet was administratively feasible and did not interfere with the discharge process (median completion time, 12.4 minutes). The response rate was 71.1 percent (424 of 596) for tablet versus 16.3 percent (96 of 588) for mail only.

Trends in Pediatric Hospitalizations and Readmissions: 2010-2016

February 2019; Pediatrics
Emily Bucholz and the CEPQM team used data from the 2010–2016 Healthcare Cost and Utilization Project Nationwide Readmissions Database and National Inpatient Sample and analyzed them to characterize patient-level and hospital-level trends in annual pediatric (ages 1–17 years) admissions and 30-day readmissions. They found that, from 2010 to 2016, the total number of index admissions decreased by 21.3 percent, but the percentage of admissions for children with complex chronic conditions increased by 5.7 percent.

Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children

January 2019; Hospital Pediatrics
David Stockwell and the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool team applied GAPPS to medical records of randomly selected pediatric patients discharged from 16 hospitals in the Pediatric Research in Inpatient Settings Network across four US regions from January 2007 to December 2012. Disparities in AEs for hospitalized children were identified on the basis of patient race/ethnicity (black, Latino, white, or other; N = 17 336 patient days) and insurance status (public, private, or self-pay/no insurance; N = 19 030 patient days). Compared with hospitalized non-Latino white children, hospitalized Latino children experienced higher rates of all AEs.

Care Quality and Spending Among Commercially Insured Children with Disabilities

June 19, 2018; Academic Pediatrics
Alyna Chien and the Children with Disabilities (CWD) team conducted a cross-sectional study comprising of 1,118,081 person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged 1 to 19 years old during 2008 to 2012. They combined the newly developed and validated Children with Disabilities Algorithm with the Pediatric Medical Complexity Algorithm to identify CWD and non-CWD subgroups. Care quality for CWD was between 11 percent and 59 percent for eight of 14 quality measures and >80 percent for the six remaining measures and was generally comparable to that for non-CWD subgroups.

Potential impact of initial clinical data on adjustment of pediatric readmission rates

July 2019; Academic Pediatrics
Mari Nakamura and the Pediatric Readmissions Measures team examined 30-day readmissions using claims and electronic health record data for patients 18 years and 29 days of age who were admitted to three children's hospitals from February 2011 to February 2014. Using the Pediatric All-Condition Readmission Measure and starting with a model including age, gender, chronic conditions, and primary diagnosis, they examined whether the addition of initial vital sign and laboratory data improved model performance. Controlling for the core model variables, low red blood cell count and mean corpuscular hemoglobin concentration and high red cell distribution width were associated with greater readmission risk.

Adverse Events in Hospitalized Pediatric Patients

August 2018; Pediatrics
David Stockwell and the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool team conducted a retrospective surveillance study of randomly selected pediatric inpatient records from 16 teaching and nonteaching hospitals. They constructed Poisson regression models with hospital random intercepts, controlling for patient age, sex, insurance, and chronic conditions, to estimate changes in AE rates over time. Examining 3,790 records, reviewers identified 414 AEs (19.1 AEs per 1000 patient days; 95 percent confidence interval [CI] 17.2–20.9) and 210 preventable AEs (9.5 AEs per 1000 patient days; 95 percent CI 8.2–10.8).

Readmission After Pediatric Mental Health Admissions

December 2017; Pediatrics
Jeremy Feng and the Pediatric Readmissions Measures team used the 2014 Healthcare Cost and Utilization Project all-payer Nationwide Readmissions Database and conducted a retrospective cohort analysis of 253,309 admissions for 5- to 17-year-olds at acute-care hospitals in 22 states. They calculated 30-day unplanned readmission rates, lengths of stay, and costs by primary admission diagnosis. They found that MH stays accounted for 18.7 percent (n = 47 397) of index admissions. The 30-day readmission rate for MH admissions was higher than for non-MH admissions (8.0 percent vs 6.2 percent; P < .001).

Impact of an Individual Mandate and Other Health Reforms on Dependent Coverage for Adolescents and Young Adults

May 30, 2017; Health Services Research
Lauren Wisk and the Adolescent Assessment of Preparation for Transition (ADAPT) Survey team used a difference-in-differences estimator to determine the rate of exit from dependent coverage, age at exit from dependent coverage, and re-uptake of dependent coverage among AYA in states with comprehensive reforms versus DCE only. Implementation of DCE with other reforms was significantly associated with a 23 percent reduction in exit from dependent coverage among AYA compared to the reduction observed for DCE alone.

Preparation for Transition to Adult Care Among Medicaid-insured Adolescents

July 1, 2017; Pediatrics
Gregory S. Sawicki, MD, MPH, and the Adolescent Assessment of Preparation for Transition (ADAPT) Survey team conducted an analysis of transition from pediatric- to adult-focused healthcare for youth with chronic illness enrolled in Medicaid. Results from 1,355 respondents across two Medicaid health plans indicate transition to adult care preparation for adolescents with chronic conditions is severely lacking.

Variation in Family Experience of Pediatric Inpatient Care As Measured by Child HCAHPS

March 22, 2017; Pediatrics
As part of a national field test of the Child HCAHPS Survey, Sara L. Toomey, MD, MPhil, MPH, MSc, and the Child HCAHPS team analyzed 17,727 Child HCAHPS surveys completed by parents of children hospitalized at 69 hospitals across 34 states. National field test results showed that family experience of pediatric inpatient care varies considerably across different hospitals and has significant room for improvement.

Quality of Primary Care for Children with Disabilities Enrolled in Medicaid

March 9, 2017; Academic Pediatrics
Alyna T. Chien, MD, MS, and the Children with Disabilities (CWD) team utilized the recently published Children with Disabilities Algorithm (CWDA) to analyze primary care quality of children enrolled in Medicaid. Their analysis revealed that 5.3 percent of Medicaid-insured children are CWD and that primary care quality for this group is sub-optimal on eight of the 12 assessed pediatric quality measures.

Potentially Preventable 30-day Hospital Readmissions at a Children’s Hospital

July 22, 2016; Pediatrics
Sara L. Toomey MD, MPH, MPhil, MSc, and the Pediatric Readmissions Measures team explored the rate of potentially preventable 30-day readmissions among 305 pediatric patients readmitted to a freestanding children’s hospital by conducting stakeholder interviews with parents, patients (if ≥13 years old), inpatient clinicians, and primary care providers. The team determined that nearly 30 percent of 30-day readmissions to children’s hospital may be preventable and that interviews provided new information about readmissions in 31 percent of cases.

Performance of the Global Assessment of Pediatric Patient Safety (GAPPS) Tool

May 24, 2016; Pediatrics
The Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality commissioned the development of a pediatric global patient safety measure. The Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool is a global patient safety tool used to measure hospital-wide rates of adverse events (AEs). Christopher P. Landrigan, MD, MPH, and the GAPPS team describe the development and testing of the GAPPS tool, which include comprehensive literature review and expert panel input, review of 3,814 medical records, analysis of inter-rater reliability, and final creation of 27 and 30 trigger manual and automated trigger lists to be used for patient safety quality improvement efforts.

Development and Validation of the Adolescent Assessment of Preparation for Transition: A Novel Patient Experience Measure

August 20, 2015; Journal of Adolescent Health
The Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality commissioned the development of a survey to assess transition of care experience of adolescent patients with chronic conditions. Gregory S. Sawicki MD, MPH, and the Adolescent Assessment of Preparation for Transition (ADAPT) Survey team developed and tested a 26-item survey to assess the preparation experience of adolescents as they move from pediatric- to adult-focused care. The team used confirmatory factor analysis to test the survey’s validity and reliability in 6,623 16- and 17-year-old adolescents with chronic health conditions.

Development of the Children with Disabilities Algorithm

September 28, 2015; Pediatrics
Alyna T. Chien, MD, MS, and the Children with Disabilities Algorithm (CWDA) team conducted a cross-sectional study that (1) ensured each of the 14,567 codes within the 2012 ICD-9-CM codebook was independently classified by three to nine pediatricians based on the code’s likelihood of indicating CWD; and (2) triangulated the resulting CWDA against parent and physician assessment of children’s disability status by using survey and chart abstraction, respectively.

Unmet Health Care Need in US Adolescents and Adult Health Outcomes

August 17, 2015; Pediatrics
Dougal S. Hargreaves, MBBChir, MD, (Res), and the Adolescent Assessment of Preparation for Transition (ADAPT) Survey team used nationally representative data from 14,800 subjects who participated in Wave I and Wave IV of the National Longitudinal Study of Adolescent to Adult Health. Logistic regression models were used to estimate the association between unmet health care need in adolescence and five self-reported measures of adult health. They found that unmet health care need was reported by 19.2 percent of adolescents and predicted worse adult health.

Same-Hospital Readmission Rates as a Measure of Pediatric Quality of Care

August 3, 2015; JAMA Pediatrics
Alisa Khan, MD, MPH, and the Pediatric Readmission Measures team analyzed all-payer inpatient claims for 701,263 pediatric discharges (patients aged 0-17 years) from 177 acute care hospitals in New York state from January 1, 2005, through November 30, 2009, to identify 30-day same-hospital readmissions (SHRs), different-hospital readmissions (DHRs), and all-hospital readmissions (AHRs). They found that different-hospital readmissions differentially affect hospitals’ pediatric readmission rates and anticipated performance, making SHRs an incomplete surrogate for AHRs — particularly for certain hospital types.

The Development of a Pediatric Inpatient Experience of Care Measure: Child HCAHPS®

July 20, 2015; Pediatrics
The Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality commissioned the development of a pediatric version of the Adult Hospital Consumer Assessment of Healthcare Providers and Systems Survey (Adult HCAHPS®). Child HCAHPS, the pediatric version, is a survey of parents/guardians of pediatric patients who were recently hospitalized. Sara L. Toomey, MD, MPhil, MPH, MSc, and the Child HCAHPS team describe the development of Child HCAHPS, which included an extensive review of the literature and quality measures, expert interviews, focus groups, cognitive testing, pilot testing of the draft survey, a national field test, psychometric analysis, and end-user testing of the final survey.

Pediatric Clinicians and Parents: Working Together for the Benefit of the Child

July 16, 2015; Academic Pediatrics
CEPQM director Mark Schuster, MD, PhD, spoke about clinician communication with families as the topic for the Academic Pediatric Association Presidential Address in April 2015. He advocates for pediatric clinicians to do all they can for parents in order to provide the best care for children.

Recognizing Differences in Pediatric Hospital Quality

June 13, 2015; Pediatrics
Jay G. Berry, MD, MPH, and the Pediatric Readmission Measures team conducted a retrospective analysis of hospital discharges for children aged 0 to 17 years from 3,974 hospitals in 44 states. For 11 measures of all-condition or condition-specific quality, they assessed the number of hospitals and states that met a “power standard” of 80 percent power for a 5 percent level significance test to detect when care is 20 percent worse than average over a three-year period. The team found that most children are admitted to hospitals in which all-condition measures of quality have adequate power to show modest differences in performance from average, but most condition-specific measures do not.

A Trigger Tool to Detect Harm in Pediatric Inpatient Settings

May 18, 2015; Pediatrics
The Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool team collaborated with Children's Hospital Association (CHA) on their effort to develop a trigger tool. They reviewed 600 patient charts and found 240 harmful events (“harms”), resulting in a rate of 40 harms per 100 patients admitted and 54.9 harms per 1,000 patient days across the six hospitals.

Measuring Quality of Pediatric Care: Where We’ve Been and Where We’re Going

March 16, 2015; Pediatrics
When CEPQM director Mark Schuster, MD, PhD, won the Douglas K. Richardson Award for Perinatal and Pediatric Healthcare Research in 2014, he gave a speech about quality measurement. Dr. Schuster starts by discussing why we measure quality and then describes where the field was two decades ago when he first started working it. He then talks about where we are now and where he hopes to see us go in the future.

Measuring Pediatric Hospital Readmission Rates to Drive Quality Improvement

September 2014; Academic Pediatrics
Mari Nakamura, MD, MPH, and the Pediatric Readmission Measures team sought to describe the importance of readmissions in children and the challenges of developing readmission quality measures. They consider findings and perspectives from research studies and commentaries in the pediatric and adult literature, characterizing arguments for and against using readmission rates as measures of pediatric quality and discussing available evidence and knowledge gaps.

Implementing national benchmarks for pediatric care quality

March 26, 2014; Pediatric Dose
Boston Children's Hospital's Clinical Health Blog interviewed CEPQM director Mark Schuster, MD, PhD, and managing director Sara Toomey, MD, MPH, about the Consumer Assessment of Healthcare Providers and Systems Hospital Survey-Child Version (Child HCAHPS) and how it fits into the overall scheme of pediatric care quality improvement. This interview was also published in the the hospital's newsletter Pediatric Dose.

Rehospitalization for Childhood Asthma: Timing, Variation, and Opportunities for Intervention

February 2014; The Journal of Pediatrics
Chén C. Kenyon, MD, and the Pediatric Readmission Measures team sought to assess the timing of pediatric asthma rehospitalization, variation in rate of rehospitalization across hospitals, and factors associated with rehospitalization at different intervals. They found that significant variation in asthma rehospitalization rates exists across children’s hospitals from seven to 365 days after an index admission. Racial/ethnic and economic disparities emerge at 60 days. By one year, rehospitalizations account for 1 in 6 hospitalizations.

Pediatric Readmission Prevalence and Variability Across Hospitals

January 2013; The Journal of the American Medical Association
Jay G. Berry, MD, MPH, and the Pediatric Readmission Measures team analyzed 568,845 admissions at 72 children's hospitals between July 1, 2009, and June 30, 2010, in the National Association of Children's Hospitals and Related Institutions Case Mix Comparative data set. They found that the 30-day unadjusted readmission rate for all hospitalized children was 6.5 percent (n = 36 734).


Please contact us with questions and comments at CEPQM@childrens.harvard.edu.