title: Agency for Healthcare Research and Quality pediatric indicators as a quality metric for surgery in children: do they predict adverse outcomes?
abstract: OBJECTIVE
  The pediatric quality indicators (PDIs) were developed by the Agency for Healthcare Research and Quality to compare patient safety and quality of pediatric care. These are being considered for mandatory reporting as well as pay-for-performance efforts. The present study evaluates the PDIs' predictive value for surgical outcomes in children.
  
  
  METHODS
  A cross-sectional study was performed using nationwide inpatient data from 1988 to 2007. Patients younger than 18 years with an inpatient surgical procedure were included and evaluated for 10 PDIs. Odds ratios for mortality, increase in length of stay, and total charges were calculated using multivariate regression adjusting for age, sex, race, region, hospital type, and comorbidities.
  
  
  RESULTS
  A total of 1,964,456 pediatric discharges were included. Mortality rates were 5.4% for patients with at least 1 PDI and 0.6% for those with none. Multivariate analysis showed that occurrence of any PDI was associated with a 20% increased risk of mortality. The PDIs were associated with an increased length of stay and total hospital charges.
  
  
  CONCLUSIONS
  The present study shows that PDIs are associated with increased mortality risk as well as increased hospital stay and total hospital charges. This provides positive evidence for the utility of these indicators as metrics for quality and patient safety.
authors.affiliation: Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0005, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rhee
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Dominic
authors.initials: D
authors.lastname: Papandria
authors.forename: Gezzer
authors.initials: G
authors.lastname: Ortega
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D061214:Patient Safety; D019984:Quality Indicators, Health Care; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality / Q000592:standards*; D014481:United States; D016270:United States Agency for Healthcare Research and Quality