Background: Although the majority of children are hospitalized in nonchildren's hospitals, little is known about the quality and safety of pediatric care in community hospitals.
Objective: The aim of this study was to conduct a scoping review and synthesize literature on the quality and safety of pediatric inpatient care in United States community hospitals.
Methods: We performed a systematic literature search in October 2016 to identify pediatric studies that reported on safety, effectiveness, efficiency, timeliness, patient-centeredness, or equity set in general, nonuniversity, or nonchildren's hospitals. We extracted data on study design, patient descriptors, and quality outcomes and assessed the risk of bias using modified Newcastle-Ottawa Scales.
Results: A total of 44 articles met the inclusion criteria. Study designs, patient populations, and quality outcome measures were heterogeneous; only three clinical domains, (1) perinatal regionalization, (2) telemedicine, and (3) imaging radiation, were explored in multiple studies with consistent directionality of results. A total of 30 studies were observational, and 22 studies compared community hospital quality outcomes with other hospital types. The remaining 14 studies reported testing of interventions; 12 showed improved quality of care postintervention. All studies reported an outcome addressing safety, effectiveness, or efficiency, whereas timeliness, patient-centeredness, and equity were infrequently addressed. Risk of bias was moderate or high for 72% of studies.
Conclusions: Literature on the inpatient care of children in community hospitals is limited, making it difficult to evaluate healthcare quality. Measures of timeliness, patient-centeredness, and equity are underrepresented. The field would benefit from more multicenter collaborations to facilitate the application of robust study designs and to enable a systematic assessment of individual interventions and community hospital quality outcomes.
Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) acute day hospital versus admission; (2) vocational rehabilitation; (3) day hospital versus outpatient care.Health Technol Assess. 2001;5(21):1-75. doi: 10.3310/hta5210. Health Technol Assess. 2001. PMID: 11532238 Review.
The quality of surgical care in safety net hospitals: a systematic review.Surgery. 2014 May;155(5):826-38. doi: 10.1016/j.surg.2013.12.006. Epub 2013 Dec 14. Surgery. 2014. PMID: 24787109 Review.
Effectiveness of culturally focused interventions in increasing the satisfaction of hospitalized Asian patients: a systematic review.JBI Database System Rev Implement Rep. 2016 Aug;14(8):219-56. doi: 10.11124/JBISRIR-2016-003048. JBI Database System Rev Implement Rep. 2016. PMID: 27635753 Review.
Promoting and supporting self-management for adults living in the community with physical chronic illness: A systematic review of the effectiveness and meaningfulness of the patient-practitioner encounter.JBI Libr Syst Rev. 2009;7(13):492-582. doi: 10.11124/01938924-200907130-00001. JBI Libr Syst Rev. 2009. PMID: 27819974
Volume and health outcomes: evidence from systematic reviews and from evaluation of Italian hospital data.Epidemiol Prev. 2017 Sep-Dec;41(5-6 (Suppl 2)):1-128. doi: 10.19191/EP17.5-6S2.P001.100. Epidemiol Prev. 2017. PMID: 29205995 English, Italian.