title: Establishing benchmarks for the hospitalized care of children with asthma, bronchiolitis, and pneumonia.
abstract: OBJECTIVE
  Asthma, pneumonia, and bronchiolitis are the leading causes of admission for pediatric patients; however, the lack of accepted benchmarks is a barrier to quality improvement efforts. Using data from children hospitalized with asthma, bronchiolitis, or pneumonia, the goals of this study were to: (1) measure the 2012 performance of freestanding children's hospitals using clinical quality indicators; and (2) construct achievable benchmarks of care (ABCs) for the clinical quality indicators.
  
  
  METHODS
  This study was a cross-sectional trial using the Pediatric Health Information System database. Patient inclusions varied according to diagnosis: asthma (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 493.0-493.92) from 2 to 18 years of age; bronchiolitis (ICD-9-CM codes 466.11 and 466.19) from 2 months to 2 years of age; and pneumonia (ICD-9-CM codes 480-486, 487.0) from 2 months to 18 years of age. ABC methods use the best-performing hospitals that comprise at least 10% of the total population to compute the benchmark.
  
  
  RESULTS
  Encounters from 42 hospitals included: asthma, 22186; bronchiolitis, 14882; and pneumonia, 12983. Asthma ABCs include: chest radiograph utilization, 24.5%; antibiotic administration, 6.6%; and ipratropium bromide use >2 days, 0%. Bronchiolitis ABCs include: chest radiograph utilization, 32.4%; viral testing, 0.6%; antibiotic administration, 18.5%; bronchodilator use >2 days, 11.4%; and steroid use, 6.4%. Pneumonia ABCs include: complete blood cell count utilization, 28.8%; viral testing, 1.5%; initial narrow-spectrum antibiotic use, 60.7%; erythrocyte sedimentation rate, 3.5%; and C-reactive protein, 0.1%.
  
  
  CONCLUSIONS
  We report achievable benchmarks for inpatient care for asthma, bronchiolitis, and pneumonia. The establishment of national benchmarks will drive improvement at individual hospitals.
authors.affiliation: Children's National Medical Center and George Washington School of Medicine, Washington, District of Columbia; kparikh@childrensnational.org.
authors.forename: Kavita
authors.initials: K
authors.lastname: Parikh
authors.affiliation: Children's Hospital Association, Overland Park, Kansas;
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas;
authors.forename: Vineeta
authors.initials: V
authors.lastname: Mittal
authors.affiliation: Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri;
authors.forename: Amanda
authors.initials: A
authors.lastname: Montalbano
authors.affiliation: Divisions of Hospital Medicine and.
authors.forename: Grant M
authors.initials: GM
authors.lastname: Mussman
authors.affiliation: Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas;
authors.forename: Rustin B
authors.initials: RB
authors.lastname: Morse
authors.affiliation: Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas;
authors.forename: Paul
authors.initials: P
authors.lastname: Hain
authors.affiliation: Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Wilson
authors.affiliation: Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; and.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D019985:Benchmarking / Q000379:methods / Q000592:standards*; D001988:Bronchiolitis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D005791:Patient Care / Q000592:standards*; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies
keywords: asthma; benchmarks; bronchiolitis; quality improvement