The federal Agency for Healthcare Research and Quality has released its first set of Pediatric Quality Indicators, developed by CHP/PCOR researchers in collaboration with investigators at UC-Davis and the Battelle Memorial Institute. The indicators, which were adapted from the AHRQ's other Quality Indicator sets (developed by the same researchers as part of the Stanford-UCSF Evidence-based Practice Center), are the first set of quality measurement tools specifically tailored to hospitalized children.

The indicators are designed to help hospitals, public health agencies, and other interested entities examine the quality of inpatient pediatric care as well as the quality of outpatient care that can be inferred from inpatient data, such as potentially preventable hospitalizations. They consist of 13 provider-level indicators, such as postoperative respiratory failure and accidental puncture or laceration, plus five geographic area-level indicators, including hospital admission rates for children with asthma, diabetes and gastroenteritis.

The AHRQ released the Pediatric QIs module, along with its supporting software and documentation, in early March. The agency commissioned the indicators in 2004 in response to requests from children's and community hospitals that sought to monitor the quality of their inpatient pediatric care but had few reliable tools to count on.

"Until now, there were a few indicators out there for pediatrics, but most of them looked at well-child care and outpatient care, or common diseases like asthma," said Sheryl Davies, CHP/PCOR project manager for the Quality Indicators project. "That left hospitals in a lurch" when it came to monitoring the quality of their pediatric care. The existing AHRQ QI sets -- the Inpatient Quality Indicators, Prevention Quality Indicators and Patient Safety Indicators -- include a few pediatric indicators, but hospitals indicated that these didn't always apply to their pediatric inpatient populations.

The release of the Pediatric QIs module represents the first phase of the project, in which indicators from the preexisting Quality Indicator sets were evaluated, reviewed and adapted for applicability to the pediatric population. In the second phase, which is now in progress and will take up to a year, entirely new pediatric indicators are being developed.

The overall project is necessary because many of the diseases or outcomes that are measured are not common in children or progress differently in children. Also, children differ from adults in important ways: They are generally healthier, are rarely hospitalized (except in complex cases), are continuously developing, are dependent on adults for care, and react differently to treatment depending on their age. Because of these differences, when adapting the Quality Indicators to children, the researchers made several modifications, including examining a broader patient population for several outcomes, and stratifying several of the indicators for high, medium and low-risk patients.

An important element of the Pediatric QIs project is the role of clinical review panels -- groups of medical experts nominated by national medical organizations in various specialties to review, assess and provide feedback on each indicator as it is being developed. Because of the dearth of evidence on measuring inpatient pediatric care, Davies said, the clinical panels have been especially important in making sure the final indicators are relevant and useful to healthcare providers.

The software, documentation and technical report for the Pediatric Quality Indicators are available at http://www.qualityindicators.ahrq.gov.

The project work was conducted by CHP/PCOR investigators Kathryn McDonald, Sheryl Davies, Corinna Haberland, Amy Ku and former staff member Kavita Choudhry, along with Patrick Romano at UC-Davis and Jeffrey Geppert of the Battelle Memorial Institute.