Development of an Achievable Benchmarks of Care Report Card for Pediatric Hospital Medicine

OBJECTIVES To develop an Achievable Benchmarks of Care (ABCs) report card for common conditions managed by pediatric hospital medicine (PHM). METHODS We performed a retrospective cross-sectional study of encounters for 13 common pediatric conditions between January 1, 2023, and December 31, 2024, using the Pediatric Health Information System database. Conditions included bronchiolitis, asthma, pneumonia, urinary tract infection, constipation, gastroenteritis, cervical lymphadenitis, skin and soft tissue infection, orbital cellulitis, osteomyelitis, septic arthritis, neonatal fever, and simple febrile seizure. Overall utilization measures included length of stay (LOS) and readmission rate. Condition-specific measures included imaging, laboratory testing, procedures, and medications ordered. ABCs were calculated using top-performing hospitals (≥10% of each cohort). For each measure, we calculated the median hospital performance, IQR, ABCs, and performance gap (difference between median performance and the ABC). RESULTS We compiled 115 measures for the 13 conditions, representing 237 283 hospitalizations or 33.5% of nonsurgical discharges among children meeting our overall inclusion/exclusion criteria. For 11 conditions, calculated ABCs for LOS were less than 48 hours. The ABC LOS for the remaining 2 conditions (osteomyelitis and septic arthritis) was less than 74 hours; these 2 conditions experienced the greatest performance gap. ABC readmission rates across all conditions were less than 2.0%. As an example of a condition-specific measure, we assessed chest radiograph performance across respiratory conditions with ABCs ranging from 20.6% to 57.9%, associated with a performance gap of 18.3% to 22.4%. CONCLUSIONS We developed a core set of PHM-specific ABCs and incorporated them into designed to support local and collaborative multicenter improvement efforts.