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J Hosp Med. 2019 Nov 1;14(10):694-703. doi: 10.12788/jhm.3268. Epub 2019 Sep 18.

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

Author information

1
The Floating Hospital for Children at Tufts Medical Center, Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts.
2
James M Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio.
3
Tufts University, Hirsh Health Sciences Library, Boston, Massachusetts.
4
Franciscan Hospital for Children, Boston, Massachusetts.
5
The Dartmouth Institute for Health Policy & Clinical Practice and Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Abstract

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.

PMID:
31532739
PMCID:
PMC6827538
[Available on 2020-11-01]
DOI:
10.12788/jhm.3268

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