Hospital care accounts for more than 40% of all pediatric healthcare expenditures in the United States, representing approximately 2 million pediatric hospitalizations annually. Lacking rigorously developed and tested measures for this setting, the quality of hospital care for children is not well understood. Hosptial-to- home care transitions and hospital-based mental healthcare are key topics representing gap areas for quality assessment and improvement in pediatrics. The overall goal of this study is to disseminate and test two new quality measure sets: the Transitions of Care Measure Set and the Mental Healthcare in Hospital Settings Measure Set in order to enhance the number of quality measures available to assess and improve pediatric hospital-based care. We will implement these measure sets in eight hospitals serving children and in four state Medicaid agencies in order to understand their validity in predicting better outcomes, their reliability in distinguishing between poor and excellent care, their feasibility of implementation in a variety of healthcare settings, and their usability for quality improvement (QI) and accountability purposes.
The specific aims of the study are: 1) To disseminate and implement the Transitions of Care and Mental healthcare in Hospital Settings measures sets in eight hospitals nationally to examine a) feasibility of tool implementation, b) quality measure validity, and c) quality measures reliability in a variety of healthcare settings, 2) To identify one quality measure from each measure set as a target for QI collaborative intervention by evaluating variation in baseline performance on individual measures within each set across the eight hospitals, 3) To improve overall performance by 50% on the two targeted measures by the end of the QI collaborative and to assess whether better performance is associated with improved outcomes, and 4) To assess the responsiveness of both a) the measures targeted for QI intervention and b) the full measure sets to the QI collaborative interventions. We will accomplish these aims by bringing together a multidisciplinary, multi-stakeholder team of experts representing state Medicaid agencies from three states, an External Quality Review Organization, eight hospitals serving children insured by Medicaid or the Child Health Insurance Program (CHIP), experts in quality measurement, dissemination and implementation science, conducting hospital-based QI collaboratives, and academic researchers.
Research and policy related to children has focused on expanding eligibility for public insurance programs, but expanding access to a system that does not deliver necessary services will not result in optimal outcomes. The Pediatric Hospital Care Improvement Project (P-HIP) is a comprehensive field test of two new quality measure sets: The Transitions of Care Measure Set, and The Mental Healthcare in Hospital Settings Measure Set. If the quality measures we propose to disseminate and test for this study are associated with better healthcare outcomes, detect meaningful variations in care, and are responsive to quality improvement interventions, they have the potential to provide critical information needed to improve hospital-based care transitions and mental healthcare for children and adolescents nationally.
