Thorough understanding and international comparisons of the health needs of children and the ways in which health systems address these needs require appropriate data
. Moreover, children are often an afterthought when health information systems are created: missing data, different methodology/patterns in developing measures for quality assessment (e.g., different coding habits for diagnosis inclusion in hospitalization rates) often prevent indicators to be transferable between countries.
Simply applying indicators to younger age ranges is insufficient because specific characteristics distinguish children from being simply ‘little adults’
[2, 3]. Optimally, indicators should be adapted to age groups and contexts of care to enable comparative evaluation of the quality of care provided by health services, particularly when health systems are different
Although some European projects have provided sets of indicators for children for primary and secondary care evaluation (Child Health Indicators of Life and Development [CHILD] project, Organization for Economic Co-operation and Development [OECD] pediatric indicators)
, few research studies focus on proper methodology to develop such indicators and adapt them to different contexts.
A systematic attempt to measure the quality of child health services has been made in the US with the Pediatric Quality Indicators (PDIs) developed by the Agency of Healthcare Research and Quality (AHRQ) in collaboration with Stanford University and the University of California
. The PDIs are a set of measures based on hospital discharge data that provide a perspective on the quality of pediatric healthcare; they focus on iatrogenic events and potentially preventable complications for patients treated in hospitals. In particular, the PDIs released in 2006 included several indicators to identify potentially avoidable hospitalizations for ‘ambulatory care-sensitive’ conditions (ACSCs). These conditions include asthma, gastroenteritis, short-term diabetes complications, perforated appendix, and urinary tract infections
The underlying concept is that timely and effective ambulatory care ensured by an integrated comprehensive system of providers and services with a preventive orientation, may avoid hospitalizations due to the mentioned conditions. According to the AHRQ, the development process of such indicators requires an empirical analysis in order to establish their validity and reliability, detect bias and design appropriate risk adjustment models before submitting candidate indicators to clinical panelists.
These quality indicators were the first set of measures developed exclusively for children using administrative databases and, to our knowledge, they have not been extensively used in Italy, even if some of them have been recently proposed by the National Outcomes Program (PNE, Programma Nazionale Esiti)
. Considering all pediatric hospitalizations due to ACSCs, dehydration/gastroenteritis is the second most common after asthma
. Gastroenteritis, in fact, is the most frequent reason for unscheduled visits to pediatricians after respiratory infections, and timely and effective care such as oral rehydration therapy may reduce the need of hospitalization
Viruses remain by far the most common cause of acute gastroenteritis in children, in both industrialized and developing countries, though other bacterial and parasitic enteropathogens can be involved in the onset of the disease
. Rotavirus is the leading cause of severe acute gastroenteritis (vomiting and severe diarrhea) among children worldwide. Rotavirus vaccine was found to prevent almost all severe rotavirus infections (85% to 98%) and 74% to 87% of all rotavirus episodes. For these reasons, the Center for Disease Control and Prevention (CDC) currently recommends the use of the two different rotavirus oral vaccines licensed for infants in the US
The introduction of the vaccination was found to be associated with a dramatic reduction in hospital admissions for acute gastroenteritis among US children during the 2008 rotavirus season
. Vaccination against the rotavirus has been recently introduced in Italy, even if not yet on a national scale, within the National Vaccination Plan 2012–14. Further investigation on the effectiveness of vaccination in reducing hospital admissions linked to dehydration/gastroenteritis in Italy would be helpful to orient national and regional policies towards increased adherence to the vaccination campaign
. This proves again the need to provide reliable and suitable indicators for monitoring activities and comparative evaluations in our healthcare setting.
The aim of the current study was to perform an empirical examination of the ‘pediatric gastroenteritis admission rate’ indicator in Italy.