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Pediatrics. 2019 Aug;144(2). pii: e20190242. doi: 10.1542/peds.2019-0242.

Pediatric Respiratory Illness Measurement System (PRIMES) Scores and Outcomes.

Author information

1
Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington; rita.mangione-smith@seattlechildrens.org.
2
Department of Pediatrics, University of Washington, Seattle, Washington.
3
Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington.
4
Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Vanderbilt University and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
5
Department of Pediatrics, School of Medicine, University of Pennsylvania and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
6
Department of Pediatrics, School of Medicine, University of Colorado and Section of Hospital Medicine, Children's Hospital Colorado, Aurora, Colorado.
7
Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and.
8
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York.

Abstract

BACKGROUND AND OBJECTIVES:

The Pediatric Respiratory Illness Measurement System (PRIMES) generates condition-specific composite quality scores for asthma, bronchiolitis, croup, and pneumonia in hospital-based settings. We sought to determine if higher PRIMES composite scores are associated with improved health-related quality of life, decreased length of stay (LOS), and decreased reuse.

METHODS:

We conducted a prospective cohort study of 2334 children in 5 children's hospitals between July 2014 and June 2016. Surveys administered on admission and 2 to 6 weeks postdischarge assessed the Pediatric Quality of Life Inventory (PedsQL). Using medical records data, 3 PRIMES scores were calculated (0-100 scale; higher scores = improved adherence) for each condition: an overall composite (including all quality indicators for the condition), an overuse composite (including only indicators for care that should not be provided [eg, chest radiographs for bronchiolitis]), and an underuse composite (including only indicators for care that should be provided [eg, dexamethasone for croup]). Multivariable models assessed relationships between PRIMES composite scores and (1) PedsQL improvement, (2) LOS, and (3) 30-day reuse.

RESULTS:

For every 10-point increase in PRIMES overuse composite scores, LOS decreased by 8.8 hours (95% confidence interval [CI] -11.6 to -6.1) for bronchiolitis, 3.1 hours (95% CI -5.5 to -1.0) for asthma, and 2.0 hours (95% CI -3.9 to -0.1) for croup. Bronchiolitis overall composite scores were also associated with shorter LOS. PRIMES composites were not associated with PedsQL improvement or reuse.

CONCLUSIONS:

Better performance on some PRIMES condition-specific composite measures is associated with decreased LOS, with scores on overuse quality indicators being a primary driver of this relationship.

PMID:
31350359
DOI:
10.1542/peds.2019-0242

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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