1. Developing and Validating a Pediatric Potentially Avoidable Transfer Quality Metric
- Author
-
Jennifer L. Rosenthal, Oluseun O. Atolagbe, Michelle Y. Hamline, Su-Ting Terry Li, Daniel J. Tancredi, Patrick S Romano, Alexis Toney, Jessica Witkowski, and Heather McKnight
- Subjects
Patient Transfer ,Male ,Adolescent ,media_common.quotation_subject ,Pediatrics ,Article ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Transfer (computing) ,Health care ,Medicine ,Humans ,Quality (business) ,Child ,Preschool ,Patient transfer ,Quality Indicators, Health Care ,media_common ,Medical Audit ,child ,business.industry ,Health Policy ,Medical record ,030208 emergency & critical care medicine ,quality indicators ,medicine.disease ,health care ,health care transitions ,Child, Preschool ,Public Health and Health Services ,Health Policy & Services ,Female ,Metric (unit) ,Medical emergency ,business ,hospitalization - Abstract
This study aimed to evaluate a quality metric that identifies pediatric potentially avoidable transfers from diagnosis and procedure codes. Using physician medical record review as the gold standard, the following steps were used: (1) develop the initial metric definition, (2) estimate initial metric definition operating characteristics, (3) refine this definition to optimize the c-statistic, and (4) validate this optimized metric definition using a separate sample. The initial metric using Sample A patient transfers had a c-statistic of 0.63 (95% confidence interval = 0.53-0.73). Following 22 revisions, the optimized metric definition was a transfer discharged within 24 hours that did not receive any of a select list of 60 268 specialized diagnoses or procedures. The optimized metric on Sample B demonstrated a sensitivity of 80.6%, specificity of 85.7%, and c-statistic of 0.83 (95% confidence interval = 0.75-0.91). The quality metric developed and validated in this study demonstrated satisfactory operating characteristics, providing a feasible means to measure this important outcome.
- Published
- 2020