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Article Reviews and Commentary

Are Hospital Characteristics Associated with Parental Views of Pediatric Inpatients Care Quality?
Co, Ferris, Marion et al. Pediatrics 2003;Vol. 111:308-314

The authors of this paper were interested in parental assessments of the quality of care their children received as inpatients in a variety of medical settings. They used reports from a diverse group of 38 hospitals that used the Picker Institutes Pediatric Inpatient Survey (PIS) to describe the quality of care for hospitalized children as experienced by parents. The PIS was developed through collaboration between the Picker Institute and Children‚s Hospital, Boston with the intention of providing hospitals with information that could be used to guide quality improvement efforts. The Institutes previously developed Adult Inpatient Survey provided the foundation for the pediatric survey. The survey instrument was mailed to parents approximately 2 weeks after the child was discharged from the hospital. Three groups of quality of care measures were used; an overall rating (Likert scale 1-5), dimension-specific problem scores (problem or not problem) and an overall problem score (an average of the dimension-specific scores). The specific dimensions investigated were: partnership, coordination of care, information to parent, information to child, physical comfort, continuity and trust. Hospitals were characterized based on their academic status, market stage and whether or not they were freestanding. There was a 48% response rate to the 26,250 surveys sent out over the period from 1/97-12/99.

Overall, the parents rated the care their child received as very good to excellent, with a mean score of 42. on the 1-5 Likert scale of overall quality. With the exception of physical comfort however, all other dimensions had problem scores > 20%. The overall ratings were noted to be most closely related improved communication and partnership. Although scores were generally close among various types of hospitals, academic health centers had somewhat higher problem scores, with 4% more problems overall and 8.5% more problems with coordination of care.

Commentary
Thomas J. Mancuso, MD, FAAP

Despite the limitations of the non-random survey with a 52% non-response rate pointed out by the authors, something can be gleaned from the paper. It is encouraging the overall the quality of care given their children was judged to be very good to excellent. Those of us who are involved in acute pain treatment should be pleased that physical comfort of the child was thought to be a problem least often of the 7 items surveyed. The presence of an Acute Pain Treatment Service was not mentioned, however. All other dimensions had scores of 24%-35%, however, indicating that all of the institutions had room for improvement. Not unexpectedly communication and coordination of care received the two scores > 30%.

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