Center for Health Statistics
Texas Health Care Information Collection
Quality of Children's Care in Texas Hospitals, 2009
This report is focused on the quality of care of children. The report includes information on hospitals that treat only children, as well as hospitals that treat both children and adults. A Guide to Understanding the Hospital-Specific Pediatric Quality Reports is available and provides more information about this report. Consumers should rely on several sources of information to make healthcare choices, and not rely solely on this report. Factors that may affect your selection of a hospital for your child include which services (benefits) your child’s health plan covers, convenience, where your child’s doctor practices and recommendations from family and friends. You can use this information to talk with your child’s doctor and hospital, and take a more active role in making health care decisions for your child.
Hospital-specific indicators of quality show how Texas hospitals performed in calendar year 2009. Hospitals may provide comments explaining their performance on the quality indicators, and these may be helpful to gain a full understanding of a hospital's score. If the hospital provided comments, its name will be followed by (C) which links to the information submitted.
Hospitals that treat only children are more likely to treat complex cases and may treat patients transferred from other hospitals. The report separates children's hospitals from other hospitals. For this report children's hospitals are defined as members of the National Association of Children’s Hospitals and Related Institutions (NACHRI) or the Children's Hospital Association of Texas (CHAT). These hospitals include freestanding children’s hospitals, children’s specialty hospitals and children’s hospitals within a larger hospital. For some larger facilities, discharges from the children’s specialty unit cannot be separated from other data for the facility. For those facilities, the information included in the reports below may include patients under age 18 discharged from other units within the hospital. Because the two types of hospitals are likely to treat children with different severities of illness or levels of complexity, comparisons of hospitals should be done with this in mind.
Information on the care of the adult population is available in Indicators of Inpatient Care in Texas Hospitals. This report on the quality of care of children is limited to children under age 18.
The database on Texas hospital performance is being developed and is currently unavailable.
Guide to Understanding the Hospital-Specific Quality of Children's Care Reports
VOLUME & MORTALITY INDICATORS FOR INPATIENT PROCEDURES
Pediatric Hearty Surgery Volume
This indicator tells the number of times heart operations on children with heart defects were done at individual hospitals. Children with birth defects involving the heart usually require highly specialized care before and after the surgery. Surgery on the hearts of infants and children is a complex process that requires close coordination between teams of cardiologists, heart surgeons, anesthesiologists, nurses and other support personnel. The medical literature suggests that special hospitals that provide this type of complex care more often may have better results. Research shows that, in general, when hospitals do these operations frequently, they are more likely to have good results. However, experts do not always agree on the minimum number of procedures needed to achieve high quality, and low-volume providers may have excellent outcomes. Since volume alone does not predict outcomes, a specific facility’s mortality indicator should also be considered. This report does not include heart operations on anyone age 18 or older.
Pediatric Heart Surgery Mortality
This indicator tells how often children died in the hospital following heart operations for heart defects or disease that was present at birth. Although the mortality (death) rate may be an indicator of the quality of care, it must be remembered that some hospitals may limit their surgeries to simpler kinds of pediatric heart surgery, and send more complex cases with a higher risk of death to other hospitals. Although this report attempts to adjust mortality rates for this factor, it is not certain that such adjustments entirely solve this problem.
This section has information about four indicators of the quality of care for children in the hospital. The information covers care provided to children under the age of 18. A quality indicator is a piece of information, a complication rate, that shows how often something that may have been preventable occurred during the child’s stay in the hospital. Because some hospitals may limit their surgeries to simpler kinds of cases, and send more complex cases with a higher risk of complications to other hospitals, it may not be appropriate to compare children's hospitals with community hospitals.
Accidental Puncture or Laceration
This indicator shows the number of injuries that occurred during a procedure, specifically accidental cuts, punctures, perforations or lacerations. These injuries can possibly be prevented through proper technique during procedures. Complex procedures can be more difficult in children than in older patients because of their size. This makes accidental injuries harder to prevent.
Postoperative Hemorrhage or Hematoma
This indicator tells how often children bled too much (called hemorrhage), or developed a large blood clot (called a hematoma) after an operation. Bleeding after a procedure or getting a blood clot can be an issue of concern for children.
Postoperative Wound Dehiscence
Wound dehiscence is the parting of the layers of a surgical wound. Either the surface layers come apart or the whole wound splits open. The complication is rare in children, but children with certain bowel or spleen disorders may be at higher risk for this to happen
Iatrogenic Pnemothorax in Non-neonates
This indicator tells how often air leaked out of a child’s lung because it was accidentally punctured (iatrogenic refers to an accidental occurrence) because of a medical procedure. Complex procedures performed near the lungs can be more difficult in children than in older patients because of their smaller lung size.
Developed by THCIC using Inpatient Quality Indicators software, Version 4.1, released December 2009 by the Agency for Healthcare Research and Quality.
Hospital admissions for these conditions can potentially be reduced with the timely and effective use of primary care. Hospitalizations may be prevented when clinicians diagnose, educate and treat patients in a timely and effective manner in outpatient settings. Higher rates of possibly preventable hospitalizations may identify areas where improvements can potentially be made in access to care or in the quality of the health care system. (maps and tables)
Information for 2008 is included in the latest version of Preventable Hospitalizations. This report also provides information for 14 conditions on potentially preventable hospitalizations of the adult population, age 18 and older, for 2008.
Quality of Children's Care in Texas Hospitals, 2008
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