Developing and Validating a Pediatric Potentially Avoidable Transfer Quality Metric

• Published in: American journal of medical quality Vol. 35; no. 2; p. 163
• Main Authors: Rosenthal, Jennifer L, Atolagbe, Oluseun, Hamline, Michelle Y, Li, Su-Ting T, Toney, Alexis, Witkowski, Jessica, McKnight, Heather, Tancredi, Daniel J, Romano, Patrick S
• Format: Journal Article
• Language: English
• Published: United States 01.03.2020
• Subjects: Adolescent; Child; Child, Preschool; Female; Humans; Male; Medical Audit; Patient Transfer - standards; Pediatrics; Quality Indicators, Health Care; health care transitions; hospitalization; patient transfer; quality indicators; health care; child
• ISSN: 1555-824X
• DOI: 10.1177/1062860619854535

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 -statistic, and (4) validate this optimized metric definition using a separate sample. The initial metric using Sample A patient transfers had a -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 -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.