title: Empirical examination of the indicator 'pediatric gastroenteritis hospitalization rate' based on administrative hospital data in Italy.
abstract: 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.
authors: Jacopo
authors: J
authors: Lenzi
authors: Lorenza
authors: L
authors: Luciano
authors: Kathryn Mack
authors: KM
authors: McDonald
authors: Simona
authors: S
authors: Rosa
authors: Gianfranco
authors: G
authors: Damiani
authors: Giovanni
authors: G
authors: Corsello
authors: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy. mariapia.fantini@unibo.it.
authors: Maria Pia
authors: MP
authors: Fantini
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001364:Awareness; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006753:Hospital Records / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors