Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review

Abstract

D espite efforts to provide high-quality healthcare, Americans die from medical errors each year and many patients do not receive recommended medical care. Risk is particularly acute during times of hospitalization. [1][2][3][4] In response, the Institute of Medicine (IOM, now the Academy of Medicine) has released "Crossing the Quality Chasm: A New Health System for the 21 st Century," providing a framework to guide delivery and measurement of high-quality healthcare. 5 Although the IOM framework has motivated the development of quality improvement (QI) and quality measurement initiatives, relatively few resources have been allocated to im-proving the quality of pediatric inpatient care. 6,7 The resultant gap in our knowledge of quality and safety of pediatric hospital-based care is further widened by the variability of settings in which children are hospitalized. These settings include freestanding children's hospitals, children's hospitals nested within larger hospitals, and community hospitals, defined as general, nonuniversity, and nonchildren's hospitals. 8 Although almost three-quarters of children needing hospitalization are cared for outside of freestanding children's hospitals, we know particularly little about the quality and safety of pediatric hospital-based care outside of these settings. 6,9 Therefore, our scoping review aims to summarize literature regarding the quality and safety of pediatric inpatient care within community hospitals. METHODSWe used a scoping review approach because this methodology, by design, is utilized to synthesize evidence and map existing literature and is particularly useful when a body of literature is heterogeneous, rendering a more targeted systematic re-

Comparing Patterns of Care for Febrile Infants at Community and University-Affiliated Hospitals

“…[14][15][16][17] Project REVISE distinguished between community and university-affiliated hospitals, employing a common definition of community hospital as a nonteaching institution. In previous systematic studies, authors have used categories from administrative databases, such as general versus freestanding children' s hospitals 1 and academic medical center, teaching, community, and specialty hospitals, 5 or a consensus definition of community hospitals as general, nonuniversity, or nonchildren' s. 18 This lack of uniformity makes comparisons between studies challenging. Moreover, the term community hospital may include a diversity of institutions, differing in size, governance, infrastructure, and geography, as well as in pediatric-specific resources.…”

“…[14][15][16][17] The consensus definition of community hospital as general, nonuniversity, or nonchildren' s does not adequately reflect the variety of hospital settings that deliver care to pediatric patients. 18 Moreover, key distinctions pertaining to pediatric care are not captured by categories in administrative databases. 1,17 McDaniel 17 has therefore called for a new way to define hospital settings through pediatric-specific services provided to characterize care delivered in limited pediatric-specific resource settings.…”

Responsibilities and Interests of Pediatricians Practicing Hospital Medicine in the United States

“…11,12 Our Professional Development Interests, Comparing Those Who Report Practicing PHM Exclusively With Those Who Report Practicing PHM in Combination With Primary and Subspecialty Care FIG. Box Plots.…”

The Costs and Benefits of Regionalized Care for Children

“…10,11 The benefits of concentrating care for children with common medical conditions at larger hospitals are similarly unknown; a paucity of research has examined the quality of pediatric care at community hospitals relative to larger academic centers. 12 Understanding the costs and benefits of regionalization for the 11.8 million children in the United States who reside in rural areas is particularly important because national surveys indicate that rural-residing children have higher rates of obesity, disability, and mental, behavioral, and developmental disorders, all of which increase hospitalization risk. [13][14][15][16] Regionalization generally puts specialized hospital care at a greater distance from rural residents, and although several studies in adult populations indicate that distance is associated with poor outcomes, this is understudied in pediatrics.…”