title: Recognizing Differences in Hospital Quality Performance for Pediatric Inpatient Care.
abstract: BACKGROUND
  Hospital quality-of-care measures are publicly reported to inform consumer choice and stimulate quality improvement. The number of hospitals and states with enough pediatric hospital discharges to detect worse-than-average inpatient care remains unknown.
  
  
  METHODS
  This study was a retrospective analysis of hospital discharges for children aged 0 to 17 years from 3974 hospitals in 44 states in the 2009 Kids' Inpatient Database. For 11 measures of all-condition or condition-specific quality, we assessed the number of hospitals and states that met a "power standard" of 80% power for a 5% level significance test to detect when care is 20% worse than average over a 3-year period. For this assessment, we approximated volume as 3 times actual 2009 admission volumes.
  
  
  RESULTS
  For all-condition quality, 1380 hospitals (87% of all pediatric discharges) and all states met the power standard for the family experience-of-care measure; 1958 hospitals (95% of discharges) and all states met the standard for adverse drug events. For condition-specific quality measures of asthma, birth, and mental health, 203 to 482 hospitals (52%-90% of condition-specific discharges) met the power standard and 40 to 44 states met the standard. One hospital and 16 states met the standard for sickle cell disease. No hospital and ≤27 states met the standard for the remaining measures studied (appendectomy, cerebrospinal fluid shunt surgery, gastroenteritis, heart surgery, and seizure).
  
  
  CONCLUSIONS
  Most children are admitted to hospitals in which all-condition measures of quality have adequate power to show modest differences in performance from average, but most condition-specific measures do not. Policies regarding incentives for pediatric inpatient quality should take these findings into account.
authors.affiliation: Division of General Pediatrics, and Division of General Pediatrics, Department of Medicine, and jay.berry@childrens.harvard.edu.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.affiliation: Division of General Pediatrics, and Division of General Pediatrics, Department of Medicine, and.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Toomey
authors.affiliation: Division of General Pediatrics, and Division of General Pediatrics, Department of Medicine, and.
authors.forename: Alyna T
authors.initials: AT
authors.lastname: Chien
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts; and.
authors.forename: Jisun
authors.initials: J
authors.lastname: Jang
authors.affiliation: Division of General Pediatrics, and.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Bryant
authors.affiliation: Division of General Pediatrics, and.
authors.forename: David J
authors.initials: DJ
authors.lastname: Klein
authors.affiliation: Division of General Pediatrics, and.
authors.forename: William J
authors.initials: WJ
authors.lastname: Kaplan
authors.affiliation: Division of General Pediatrics, and Division of General Pediatrics, Department of Medicine, and.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D011787:Quality of Health Care; D012189:Retrospective Studies