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

Arti D Desai; Q Burkhart; Layla Parast; Tamara D Simon; Carolyn Allshouse; Maria T Britto; JoAnna K Leyenaar; Courtney A Gidengil; Sara L Toomey; Marc N Elliott; Eric C Schneider; Rita Mangione-Smith

doi:10.1016/j.acap.2016.07.008

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

Acad Pediatr. 2016 Nov-Dec;16(8):760-769. doi: 10.1016/j.acap.2016.07.008. Epub 2016 Aug 2.

Authors

Affiliations

¹ Department of Pediatrics, University of Washington, Seattle, WA; Seattle Children's Research Institute, Seattle, WA. Electronic address: arti.desai@seattlechildrens.org.
² RAND Corporation, Santa Monica, Calif.
³ Department of Pediatrics, University of Washington, Seattle, WA; Seattle Children's Research Institute, Seattle, WA.
⁴ Family Voices of Minnesota, Stillwater, Minn.
⁵ Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
⁶ Department of Pediatrics, Tufts University, Boston, Mass.
⁷ RAND Corporation, Boston, Mass; Harvard Medical School, Boston, Mass; Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass.
⁸ Harvard Medical School, Boston, Mass.
⁹ The Commonwealth Fund, New York, NY.

Abstract

Background: 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.

Keywords: emergency medicine; hospitalists; hospitals; inpatients; pediatrics; quality of care: outcome and process assessment (health care).

MeSH terms

Adolescent
Adult
Aftercare
Ambulatory Care*
Caregivers*
Child
Child, Preschool
Delphi Technique
Emergency Service, Hospital*
Evidence-Based Practice
Female
Hospitalization*
Hospitals, Pediatric
Humans
Infant
Male
Pediatrics / standards*
Pilot Projects
Postal Service
Quality Assurance, Health Care*
Quality Indicators, Health Care*
Random Allocation
Surveys and Questionnaires
Telephone
Transitional Care / standards*

Grants and funding

U18 HS020506/HS/AHRQ HHS/United States