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A Pediatric Respiratory Illness Report Card of Quality Measures: Helpful in Learning our ABCs (Achievable Benchmarks of Care)

July 5, 2023

There is significant variability in the emergency department (EDs) and inpatient care of children with respiratory illnesses. To reduce inappropriate variation, we need better quality measures. We are early releasing an article in Pediatrics by Reyes et al that describes a set of comprehensive quality measures for respiratory illnesses (10.1542/peds.2022-058389). They describe how these were developed, how they can be automated within the electronic health record, and how these quality measures can be used to assess achievable benchmarks of care (ABCs). Achievable benchmarks of care are performance metrics achieved by the top 10% of EDs or inpatient facilities. The dataset used to develop these metrics included 984,337 patient encounters from 2017 to 2019 seen in the ED or inpatient setting of the 49 free-standing children’s hospitals that are part of the Pediatric Health Information System data registry. Together, these measures form the Pediatric Respiratory Illness (PRI) report. 

The authors also share trends in ABCs over time for some respiratory illnesses. While there is a lot of good news about improvements in care, there are some notable items to improve. For example, 19.7% of the patients seen in the ED still received bronchodilators for treatment of bronchiolitis despite their lack of effectiveness. Similarly, chest X-rays for bronchiolitis were ordered 14.4% of the time in the ED, with even higher rates for inpatients. Compared to prior reports on ABCs published in our journal,1-4 most quality measures showed improvement over time. While this study’s analysis stopped just prior to the COVID-19 pandemic, it establishes a baseline of what was achievable prior to the COVID-19 pandemic.

This study will enable you to use your electronic health record data to track the same measures for respiratory illness and see how close your ED or hospital is performing in regard to the achievable benchmarks of the top 10%. You and your patients will breathe easier if you review the useful data contained in this study and adopt the PRI report for emergency department or inpatient setting. Link to this study and learn more.


  1. Knapp JF, Hall M, Sharma V. Benchmarks for the emergency department care of children with asthma, bronchiolitis, and croup. Pediatr Emerg Care. 2010;26(5):364–369
  2. Parikh K, Hall M, Mittal V, et al. Establishing benchmarks for the hospitalized care of children with asthma, bronchiolitis, and pneumonia. Pediatrics. 2014;134(3):555–562
  3. Ralston S, Parikh K, Goodman D. Benchmarking overuse of medical interventions for bronchiolitis. JAMA Pediatr. 2015;169(9):805–806
  4. Reyes M, Paulus E, Hronek C, et al. Choosing wisely campaign: report card and achievable benchmarks of care for children’s hospitals. Hosp Pediatr. 2017;7(11):633–641


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