Cargando…

Empirical examination of the indicator ‘pediatric gastroenteritis hospitalization rate’ based on administrative hospital data in Italy

BACKGROUND: Awareness of the importance of strengthening investments in child health and monitoring the quality of services in the pediatric field is increasing. The Pediatric Quality Indicators developed by the US Agency for Healthcare Research and Quality (AHRQ), use hospital administrative data t...

Descripción completa

Detalles Bibliográficos
Autores principales: Lenzi, Jacopo, Luciano, Lorenza, McDonald, Kathryn Mack, Rosa, Simona, Damiani, Gianfranco, Corsello, Giovanni, Fantini, Maria Pia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3923239/
https://www.ncbi.nlm.nih.gov/pubmed/24512747
http://dx.doi.org/10.1186/1824-7288-40-14
_version_ 1782303591081443328
author Lenzi, Jacopo
Luciano, Lorenza
McDonald, Kathryn Mack
Rosa, Simona
Damiani, Gianfranco
Corsello, Giovanni
Fantini, Maria Pia
author_facet Lenzi, Jacopo
Luciano, Lorenza
McDonald, Kathryn Mack
Rosa, Simona
Damiani, Gianfranco
Corsello, Giovanni
Fantini, Maria Pia
author_sort Lenzi, Jacopo
collection PubMed
description BACKGROUND: Awareness of the importance of strengthening investments in child health and monitoring the quality of services in the pediatric field is increasing. The Pediatric Quality Indicators developed by the US Agency for Healthcare Research and Quality (AHRQ), use hospital administrative data to identify admissions that could be avoided through high-quality outpatient care. Building on this approach, the purpose of this study is to perform an empirical examination of the ‘pediatric gastroenteritis admission rate’ indicator in Italy, under the assumption that lower admission rates are associated with better management at the primary care level and with overall better quality of care for children. METHODS: Following the AHRQ process for evaluating quality indicators, we examined age exclusion/inclusion criteria, selection of diagnostic codes, hospitalization type, and methodological issues for the ‘pediatric gastroenteritis admission rate’. The regional variability of hospitalizations was analyzed for Italian children aged 0–17 years discharged between January 1, 2009 and December 31, 2011. We considered hospitalizations for the following diagnoses: non-bacterial gastroenteritis, bacterial gastroenteritis and dehydration (along with a secondary diagnosis of gastroenteritis). The data source was the hospital discharge records database. All rates were stratified by age. RESULTS: In the study period, there were 61,130 pediatric hospitalizations for non-bacterial gastroenteritis, 5,940 for bacterial gastroenteritis, and 38,820 for dehydration. In <1-year group, the relative risk of hospitalization for non-bacterial gastroenteritis was 24 times higher than in adolescents, then it dropped to 14.5 in 1- to 4-year-olds and to 3.2 in 5- to 9-year-olds. At the national level, the percentage of admissions for bacterial gastroenteritis was small compared with non-bacterial, while including admissions for dehydration revealed a significant variability in diagnostic coding among regions that affected the regional performance of the indicator. CONCLUSIONS: For broadest application, we propose a ‘pediatric gastroenteritis admission rate’ that consists of including bacterial gastroenteritis and dehydration diagnoses in the numerator, as well as infants aged <3 months. We also suggest adjusting for age and including day hospital admissions. Future evaluation by a clinical panel at the national level might be helpful to determine appropriate application for such measures, and make recommendations to policy makers.
format Online
Article
Text
id pubmed-3923239
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-39232392014-02-14 Empirical examination of the indicator ‘pediatric gastroenteritis hospitalization rate’ based on administrative hospital data in Italy Lenzi, Jacopo Luciano, Lorenza McDonald, Kathryn Mack Rosa, Simona Damiani, Gianfranco Corsello, Giovanni Fantini, Maria Pia Ital J Pediatr Research BACKGROUND: Awareness of the importance of strengthening investments in child health and monitoring the quality of services in the pediatric field is increasing. The Pediatric Quality Indicators developed by the US Agency for Healthcare Research and Quality (AHRQ), use hospital administrative data to identify admissions that could be avoided through high-quality outpatient care. Building on this approach, the purpose of this study is to perform an empirical examination of the ‘pediatric gastroenteritis admission rate’ indicator in Italy, under the assumption that lower admission rates are associated with better management at the primary care level and with overall better quality of care for children. METHODS: Following the AHRQ process for evaluating quality indicators, we examined age exclusion/inclusion criteria, selection of diagnostic codes, hospitalization type, and methodological issues for the ‘pediatric gastroenteritis admission rate’. The regional variability of hospitalizations was analyzed for Italian children aged 0–17 years discharged between January 1, 2009 and December 31, 2011. We considered hospitalizations for the following diagnoses: non-bacterial gastroenteritis, bacterial gastroenteritis and dehydration (along with a secondary diagnosis of gastroenteritis). The data source was the hospital discharge records database. All rates were stratified by age. RESULTS: In the study period, there were 61,130 pediatric hospitalizations for non-bacterial gastroenteritis, 5,940 for bacterial gastroenteritis, and 38,820 for dehydration. In <1-year group, the relative risk of hospitalization for non-bacterial gastroenteritis was 24 times higher than in adolescents, then it dropped to 14.5 in 1- to 4-year-olds and to 3.2 in 5- to 9-year-olds. At the national level, the percentage of admissions for bacterial gastroenteritis was small compared with non-bacterial, while including admissions for dehydration revealed a significant variability in diagnostic coding among regions that affected the regional performance of the indicator. CONCLUSIONS: For broadest application, we propose a ‘pediatric gastroenteritis admission rate’ that consists of including bacterial gastroenteritis and dehydration diagnoses in the numerator, as well as infants aged <3 months. We also suggest adjusting for age and including day hospital admissions. Future evaluation by a clinical panel at the national level might be helpful to determine appropriate application for such measures, and make recommendations to policy makers. BioMed Central 2014-02-11 /pmc/articles/PMC3923239/ /pubmed/24512747 http://dx.doi.org/10.1186/1824-7288-40-14 Text en Copyright © 2014 Lenzi et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Lenzi, Jacopo
Luciano, Lorenza
McDonald, Kathryn Mack
Rosa, Simona
Damiani, Gianfranco
Corsello, Giovanni
Fantini, Maria Pia
Empirical examination of the indicator ‘pediatric gastroenteritis hospitalization rate’ based on administrative hospital data in Italy
title Empirical examination of the indicator ‘pediatric gastroenteritis hospitalization rate’ based on administrative hospital data in Italy
title_full Empirical examination of the indicator ‘pediatric gastroenteritis hospitalization rate’ based on administrative hospital data in Italy
title_fullStr Empirical examination of the indicator ‘pediatric gastroenteritis hospitalization rate’ based on administrative hospital data in Italy
title_full_unstemmed Empirical examination of the indicator ‘pediatric gastroenteritis hospitalization rate’ based on administrative hospital data in Italy
title_short Empirical examination of the indicator ‘pediatric gastroenteritis hospitalization rate’ based on administrative hospital data in Italy
title_sort empirical examination of the indicator ‘pediatric gastroenteritis hospitalization rate’ based on administrative hospital data in italy
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3923239/
https://www.ncbi.nlm.nih.gov/pubmed/24512747
http://dx.doi.org/10.1186/1824-7288-40-14
work_keys_str_mv AT lenzijacopo empiricalexaminationoftheindicatorpediatricgastroenteritishospitalizationratebasedonadministrativehospitaldatainitaly
AT lucianolorenza empiricalexaminationoftheindicatorpediatricgastroenteritishospitalizationratebasedonadministrativehospitaldatainitaly
AT mcdonaldkathrynmack empiricalexaminationoftheindicatorpediatricgastroenteritishospitalizationratebasedonadministrativehospitaldatainitaly
AT rosasimona empiricalexaminationoftheindicatorpediatricgastroenteritishospitalizationratebasedonadministrativehospitaldatainitaly
AT damianigianfranco empiricalexaminationoftheindicatorpediatricgastroenteritishospitalizationratebasedonadministrativehospitaldatainitaly
AT corsellogiovanni empiricalexaminationoftheindicatorpediatricgastroenteritishospitalizationratebasedonadministrativehospitaldatainitaly
AT fantinimariapia empiricalexaminationoftheindicatorpediatricgastroenteritishospitalizationratebasedonadministrativehospitaldatainitaly