Development and Pilot Testing of Caregiver-Reported Pediatric Quality Measures for Transitions Between Sites of Care

Published in: Academic Pediatrics, v. 16, no. 8, Nov.-Dec. 2016, p. 760-769

Posted on RAND.org on November 28, 2016

by Arti D. Desai, Q. Burkhart, Layla Parast, Tamara D. Simon, Carolyn Allshouse, Maria T Britto, JoAnna K. Leyenaar, Courtney A. Gidengil, Sara L Toomey, Marc N. Elliott, Eric C. Schneider, Rita Mangione-Smith

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Background

Few measures exist to assess pediatric transition quality between care settings. The study objective was to develop and pilot test caregiver-reported quality measures for pediatric hospital and emergency department (ED) to home transitions.

Methods

On the basis of an evidence review, we developed draft caregiver-reported quality measures for transitions between sites of care. Using the RAND-UCLA Modified Delphi method, a multistakeholder panel endorsed measures for further development. Measures were operationalized into 2 surveys, which were administered to caregivers of patients (n = 2839) discharged from Seattle Children's Hospital between July 1 and September 1, 2014. Caregivers were randomized to mail or telephone survey mode. Measure scores were computed as a percentage of eligible caregivers who endorsed receiving the indicated care. Differences in scores were examined according to survey mode and caregiver characteristics.

Results

The Delphi panel endorsed 6 of 8 hospital to home transition measures and 2 of 3 ED to home transitions measures. Scores differed significantly according to mode for 1 measure. Caregivers with lower levels of educational attainment and/or Spanish-speaking caregivers reported significantly higher scores on 3 of the measures. The largest difference was reported for the measure that assessed whether caregivers received assistance with scheduling follow-up appointments; 92% score for caregivers with lower educational attainment versus 79% for caregivers with higher educational attainment (P < .001).

Conclusions

We developed 8 new, evidence-based quality measures to assess transition quality from the perspective of caregivers. Pilot testing of these measures in a single institution yielded valuable insights for future testing and implementation of these measures.

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