Metric Development for the Multicenter Improving Pediatric Sepsis Outcomes (IPSO) Collaborative.
Journal
Pediatrics
ISSN: 1098-4275
Titre abrégé: Pediatrics
Pays: United States
ID NLM: 0376422
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
accepted:
22
01
2021
pubmed:
3
4
2021
medline:
16
9
2021
entrez:
2
4
2021
Statut:
ppublish
Résumé
A 56 US hospital collaborative, Improving Pediatric Sepsis Outcomes, has developed variables, metrics and a data analysis plan to track quality improvement (QI)-based patient outcomes over time. Improving Pediatric Sepsis Outcomes expands on previous pediatric sepsis QI efforts by improving electronic data capture and uniformity across sites. An expert panel developed metrics and corresponding variables to assess improvements across the care delivery spectrum, including the emergency department, acute care units, hematology and oncology, and the ICU. Outcome, process, and balancing measures were represented. Variables and statistical process control charts were mapped to each metric, elucidating progress over time and informing plan-do-study-act cycles. Electronic health record (EHR) abstraction feasibility was prioritized. Time 0 was defined as time of earliest sepsis recognition (determined electronically), or as a clinically derived time 0 (manually abstracted), identifying earliest physiologic onset of sepsis. Twenty-four evidence-based metrics reflected timely and appropriate interventions for a uniformly defined sepsis cohort. Metrics mapped to statistical process control charts with 44 final variables; 40 could be abstracted automatically from multiple EHRs. Variables, including high-risk conditions and bedside huddle time, were challenging to abstract (reported in <80% of encounters). Size or type of hospital, method of data abstraction, and previous QI collaboration participation did not influence hospitals' abilities to contribute data. To date, 90% of data have been submitted, representing 200 007 sepsis episodes. A comprehensive data dictionary was developed for the largest pediatric sepsis QI collaborative, optimizing automation and ensuring sustainable reporting. These approaches can be used in other large-scale sepsis QI projects in which researchers seek to leverage EHR data abstraction.
Sections du résumé
BACKGROUND
A 56 US hospital collaborative, Improving Pediatric Sepsis Outcomes, has developed variables, metrics and a data analysis plan to track quality improvement (QI)-based patient outcomes over time. Improving Pediatric Sepsis Outcomes expands on previous pediatric sepsis QI efforts by improving electronic data capture and uniformity across sites.
METHODS
An expert panel developed metrics and corresponding variables to assess improvements across the care delivery spectrum, including the emergency department, acute care units, hematology and oncology, and the ICU. Outcome, process, and balancing measures were represented. Variables and statistical process control charts were mapped to each metric, elucidating progress over time and informing plan-do-study-act cycles. Electronic health record (EHR) abstraction feasibility was prioritized. Time 0 was defined as time of earliest sepsis recognition (determined electronically), or as a clinically derived time 0 (manually abstracted), identifying earliest physiologic onset of sepsis.
RESULTS
Twenty-four evidence-based metrics reflected timely and appropriate interventions for a uniformly defined sepsis cohort. Metrics mapped to statistical process control charts with 44 final variables; 40 could be abstracted automatically from multiple EHRs. Variables, including high-risk conditions and bedside huddle time, were challenging to abstract (reported in <80% of encounters). Size or type of hospital, method of data abstraction, and previous QI collaboration participation did not influence hospitals' abilities to contribute data. To date, 90% of data have been submitted, representing 200 007 sepsis episodes.
CONCLUSIONS
A comprehensive data dictionary was developed for the largest pediatric sepsis QI collaborative, optimizing automation and ensuring sustainable reporting. These approaches can be used in other large-scale sepsis QI projects in which researchers seek to leverage EHR data abstraction.
Identifiants
pubmed: 33795482
pii: peds.2020-017889
doi: 10.1542/peds.2020-017889
pmc: PMC8131032
mid: NIHMS1692454
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : AHRQ HHS
ID : K08 HS025696
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK119463
Pays : United States
Informations de copyright
Copyright © 2021 by the American Academy of Pediatrics.
Déclaration de conflit d'intérêts
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
Références
Lancet. 2010 Jun 5;375(9730):1969-87
pubmed: 20466419
Pediatr Clin North Am. 2018 Dec;65(6):1269-1281
pubmed: 30446062
Pediatrics. 2014 May;133(5):e1358-66
pubmed: 24709937
Congenit Heart Dis. 2019 Jul;14(4):665-670
pubmed: 31290585
Pediatrics. 2011 Mar;127(3):e758-66
pubmed: 21339277
JAMA. 2018 Jul 24;320(4):358-367
pubmed: 30043064
Crit Care Med. 2020 Oct;48(10):e916-e926
pubmed: 32931197
BMC Health Serv Res. 2018 Dec 29;18(1):1005
pubmed: 30594193
Pediatr Crit Care Med. 2020 Feb;21(2):e52-e106
pubmed: 32032273
Med Care. 2003 Jan;41(1 Suppl):I30-8
pubmed: 12544814
Qual Manag Health Care. 2017 Jan/Mar;26(1):33-39
pubmed: 28030463
Crit Care Med. 2017 Jun;45(6):1061-1093
pubmed: 28509730
Pediatrics. 2012 Aug;130(2):e273-80
pubmed: 22753559
Pediatrics. 2021 Jan;147(1):
pubmed: 33328337
JAMA. 2010 Oct 20;304(15):1715-6
pubmed: 20959584
Pediatr Crit Care Med. 2013 Sep;14(7):686-93
pubmed: 23897242
Crit Care Med. 2013 May;41(5):1167-74
pubmed: 23442987
Crit Care Med. 2013 Feb;41(2):580-637
pubmed: 23353941
Pediatr Crit Care Med. 2016 Jan;17(1):2-9
pubmed: 26492059
N Engl J Med. 2007 Feb 1;356(5):515-7
pubmed: 17259445
Pediatr Qual Saf. 2017 Dec 29;3(1):e051
pubmed: 30229187
Pediatr Emerg Care. 2008 Dec;24(12):810-5
pubmed: 19050666
J Pediatr. 2015 Dec;167(6):1295-300.e4
pubmed: 26470685
PLoS One. 2011;6(6):e20476
pubmed: 21694759
Pediatr Crit Care Med. 2005 Jan;6(1):2-8
pubmed: 15636651
J Healthc Qual. 2008 May-Jun;30(3):51-5
pubmed: 18507241
J Am Board Fam Med. 2017 1/2;30(1):4-7
pubmed: 28062809
Med Care. 2003 Jan;41(1 Suppl):I71-9
pubmed: 12544818
Pediatr Crit Care Med. 2014 Nov;15(9):798-805
pubmed: 25162514
N Engl J Med. 2010 Dec 23;363(26):2477-81
pubmed: 21142528
Curr Gastroenterol Rep. 2015 Apr;17(4):14
pubmed: 25762473
Pediatrics. 2016 Oct;138(4):
pubmed: 27604184
Inflamm Bowel Dis. 2011 Oct;17(10):2184-91
pubmed: 21456033
JAMA. 1988 Sep 23-30;260(12):1743-8
pubmed: 3045356
Am J Respir Crit Care Med. 2012 Dec 15;186(12):1264-71
pubmed: 23087028
Ann Surg. 2020 Jun;271(6):1048-1055
pubmed: 31850998