Development and Pilot Testing of Caregiver-Reported Pediatric Quality Measures for Transitions Between Sites of Care

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• 作者：Arti D. Desai ; MD ; MSPH^a ; ^b ; ^{arti.desai@seattlechildrens.org" class="auth_mail" title="E-mail the corresponding author} ; Q. Burkhart ; MS^c ; Layla Parast ; PhD^c ; Tamara D. Simon ; MD ; MSPH^a ; ^b ; Carolyn Allshouse^d ; Maria T. Britto ; MD ; MPH^e ; JoAnna K. Leyenaar ; MD ; MPH^f ; Courtney A. Gidengil ; MD ; MPH^g ; ^h ; ^j ; Sara L. Toomey ; MD ; MPhil ; MPH ; MSc^h ; Marc N. Elliott ; PhD^c ; Eric C. Schneider ; MDⁱ ; Rita Mangione-Smith ; MD ; MPH^a ; ^b
• 关键词：emergency medicine ; hospitalists ; hospitals ; inpatients ; pediatrics ; quality of care ; outcome and process assessment (health care)
• 刊名：Academic Pediatrics
• 出版年：2016
• 出版时间：November-December 2016
• 年：2016
• 卷：16
• 期：8
• 页码：760-769
• 全文大小：276 K

文摘

Few measures exist to assess pediatric transition quality between care settings. The study objective was to develop and pilot test caregiver-reported quality measures for pediatric hospital and emergency department (ED) to home transitions.

Methods

On the basis of an evidence review, we developed draft caregiver-reported quality measures for transitions between sites of care. Using the RAND-UCLA Modified Delphi method, a multistakeholder panel endorsed measures for further development. Measures were operationalized into 2 surveys, which were administered to caregivers of patients (n = 2839) discharged from Seattle Children's Hospital between July 1 and September 1, 2014. Caregivers were randomized to mail or telephone survey mode. Measure scores were computed as a percentage of eligible caregivers who endorsed receiving the indicated care. Differences in scores were examined according to survey mode and caregiver characteristics.

Results

The Delphi panel endorsed 6 of 8 hospital to home transition measures and 2 of 3 ED to home transitions measures. Scores differed significantly according to mode for 1 measure. Caregivers with lower levels of educational attainment and/or Spanish-speaking caregivers reported significantly higher scores on 3 of the measures. The largest difference was reported for the measure that assessed whether caregivers received assistance with scheduling follow-up appointments; 92% score for caregivers with lower educational attainment versus 79% for caregivers with higher educational attainment (P < .001).

Conclusions

We developed 8 new, evidence-based quality measures to assess transition quality from the perspective of caregivers. Pilot testing of these measures in a single institution yielded valuable insights for future testing and implementation of these measures.