SPECIALE RICERCA Un Audit su 4 malattie e 104 ospedali

Objectives: To assess quality of care for 4 common diseases (pneumonia, asthma, urinary tract infections and recurrent abdominal pain) in a large sample of italian paediatric inpatient services; to evaluate feasibility and usefulness of a network of paediatric hospital service aimed at improving quality of care through peer review of case-management practices. Methods: 104 paediatric hospital services were involved and 2141 cases were analyzed: 1212 cases of pneumonia (P), 391 cases of asthma (A), 288 of recurrent abdominal pain (RAP) and 250 of acute pyelonephritis (APN) were assessed; admission procedures, diagnostic and therapeutic interventions, lenght of hospital stay and other relevant information was recorded on an ad hoc data recording form and then analyzed by a group of paediatricians belonging to the hospital services involved in the study. Results: The observed case-management practices differed significantly from the currently accepted recommendations in many aspects. Only a third of hospital admissions was directly referred by the family paediatricians. Diagnostic procedures were often overabundant, while in one specific instance (RAP) they failed to meet the minimum requisites. In over half of BP and APN cases antibiotics were administered parenterally without clear indications. Instructions for self-management of A appeared insufficient so that the rate of recurrent admissions for A was too high. The lenght of hospital stay for each disease was variable across paediatric services without any real difference in the severity of cases. The findings were ultimately presented and discussed with the participation of a large proportion of the hospitals involved in the survey. The need for establishing guidelines for the case-management of the most common paediatric diseases was widely recognized. Conclusions: Interinstitutional peer review of clinical practices is a feasible and useful approach to assessing and improving quality of care in paediatric hospital services.