A novel report card was developed on the basis of the SHM-CWC pediatric recommendations, including ABCs. We found variance in practices among institutions and gaps between hospital performances and ABCs. These findings represent a roadmap for improvement.

Current national health care expenditures are ∼$3 trillion, with ∼12% directed toward the provision of care to children. 1 With ∼6 million children hospitalized every year, ∼40% of the costs of treating children is attributable to inpatient care. 2 The moral and humanistic motivation to improve the quality of care of hospitalized children is consistent with the core ethical principles of beneficence and nonmaleficence. Also, economic drivers that are focused on value and efficiency for pediatric health care exist. As a result, the government, providers, hospitals, patients, families, insurers, and accreditation organizations are all interested in clinical and other relevant measures as critical tools to improve care. 3,4 Quality measures (QMs) for assessment of the care provided to hospitalized children in the United States were remarkably sparse at the beginning of the century. As of 2006, few measure sets were exclusively designated to assess the quality of care for children, and none existed for hospital care. 5 By to 2008, only 5% of the available QMs for children' s health care were devoted to inpatient care. 2

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