Pediatric Respiratory Illness Measurement System (PRIMES) Scores and Outcomes.

TitlePediatric Respiratory Illness Measurement System (PRIMES) Scores and Outcomes.
Publication TypeJournal Article
Year of Publication2019
AuthorsMangione-Smith R, Zhou C, Williams DJ, Johnson DP, Kenyon CC, Tyler A, Quinonez R, Vachani J, McGalliard J, Tieder JS, Simon TD, Wilson KM
Corporate AuthorsPediatric Research in Inpatient Settings(PRIS) Network
JournalPediatrics
Date Published2019 Jul 26
ISSN1098-4275
Abstract

BACKGROUND AND OBJECTIVES: The Pediatric Respiratory Illness Measurement System (PRIMES) generates condition-specific composite quality scores for asthma, bronchiolitis, croup, and pneumonia in hospital-based settings. We sought to determine if higher PRIMES composite scores are associated with improved health-related quality of life, decreased length of stay (LOS), and decreased reuse.

METHODS: We conducted a prospective cohort study of 2334 children in 5 children's hospitals between July 2014 and June 2016. Surveys administered on admission and 2 to 6 weeks postdischarge assessed the Pediatric Quality of Life Inventory (PedsQL). Using medical records data, 3 PRIMES scores were calculated (0-100 scale; higher scores = improved adherence) for each condition: an overall composite (including all quality indicators for the condition), an overuse composite (including only indicators for care that should not be provided [eg, chest radiographs for bronchiolitis]), and an underuse composite (including only indicators for care that should be provided [eg, dexamethasone for croup]). Multivariable models assessed relationships between PRIMES composite scores and (1) PedsQL improvement, (2) LOS, and (3) 30-day reuse.

RESULTS: For every 10-point increase in PRIMES overuse composite scores, LOS decreased by 8.8 hours (95% confidence interval [CI] -11.6 to -6.1) for bronchiolitis, 3.1 hours (95% CI -5.5 to -1.0) for asthma, and 2.0 hours (95% CI -3.9 to -0.1) for croup. Bronchiolitis overall composite scores were also associated with shorter LOS. PRIMES composites were not associated with PedsQL improvement or reuse.

CONCLUSIONS: Better performance on some PRIMES condition-specific composite measures is associated with decreased LOS, with scores on overuse quality indicators being a primary driver of this relationship.

DOI10.1542/peds.2019-0242
Alternate JournalPediatrics
PubMed ID31350359