Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review
BACKGROUND: Although the majority of children are hospitalized in nonchildren's hospitals, little is known about the quality and safety of pediatric care in community hospitals.
OBJECTIVE: The aim of this study was to conduct a scoping review and synthesize literature on the quality and safety of pediatric inpatient care in United States community hospitals.
METHODS: We performed a systematic literature search in October 2016 to identify pediatric studies that reported on safety, effectiveness, efficiency, timeliness, patient-centeredness, or equity set in general, nonuniversity, or nonchildren’s hospitals. We extracted data on study design, patient descriptors, and quality outcomes and assessed the risk of bias using modified Newcastle-Ottawa Scales.
RESULTS: A total of 44 articles met the inclusion criteria. Study designs, patient populations, and quality outcome measures were heterogeneous; only three clinical domains, (1) perinatal regionalization, (2) telemedicine, and (3) imaging radiation, were explored in multiple studies with consistent directionality of results. A total of 30 studies were observational, and 22 studies compared community hospital quality outcomes with other hospital types. The remaining 14 studies reported testing of interventions; 12 showed improved quality of care postintervention. All studies reported an outcome addressing safety, effectiveness, or efficiency, whereas timeliness, patient-centeredness, and equity were infrequently addressed. Risk of bias was moderate or high for 72% of studies.
CONCLUSIONS: Literature on the inpatient care of children in community hospitals is limited, making it difficult to evaluate healthcare quality. Measures of timeliness, patient-centeredness, and equity are underrepresented. The field would benefit from more multicenter collaborations to facilitate the application of robust study designs and to enable a systematic assessment of individual interventions and community hospital quality outcomes.
© 2019 Society of Hospital Medicine
CONCLUSIONS
Recognizing that more than half of all children admitted to hospitals in the US receive their care at community hospitals, understanding healthcare quality in community hospitals is important. This scoping review underscores the need for additional research and higher quality evidence to determine the quality of pediatric inpatient care in these settings and identifies some particularly wide gaps that could be targeted in future research. Acknowledging that further research is necessary to address all aims of quality healthcare, markedly few studies have examined timeliness, equity, or patient-centeredness. Collaborations between academic medical centers and community hospitals may be an effective means to connect researchers with community hospital clinical teams to facilitate the application of robust study designs and analytic approaches and to facilitate multisite investigations. Research in this field would benefit from a standardized definition of a community hospital that could be consistently applied in research and QI endeavors.
Disclosures
The authors have no potential conflicts of interest to disclose.
Funding
Jana Leary was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Grant Number 5TL1TR0001062-03. JoAnna Leyenaar was supported by the Agency for Healthcare Research and Quality (K08HS024133).
Disclaimer
The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the AHRQ.
