USF St. Petersburg campus Faculty Publications


Differences in quality of care among non-safety-net, safety-net, and children's hospitals.

SelectedWorks Author Profiles:

Richard B. Smith

Document Type


Publication Date





OBJECTIVE: To understand factors associated with pediatric inpatient safety events, we test 2 hypotheses: (1) scarce resources (as measured by Medicaid burden) in safety-net hospitals relative to non–safety-net hospitals result in higher rates of safety events; and (2) higher levels of severity and more chronic conditions in patient populations lead to higher rates of safety events within hospital category and in children’s hospitals in comparison with non-children’s hospitals. METHODS: All nonnewborn pediatric hospital discharge records, which met criteria for potentially experiencing at least 1 pediatric quality indicator (PDI) event (using Agency for Healthcare Research and Quality’s 2009 Nationwide Inpatient Sample and PDI) and weighted to represent national level estimates, were analyzed for patterns of PDI events within and across hospital categories by using bivariate comparisons and multivariable logit models with robust SEs. The outcome measure “ANY PDI” captures the number of pediatric discharges at the hospital level with 1 or more PDI event. RESULTS: High Medicaid burden does not seem to be a factor in the likelihood of ANY PDI. Severity of illness (adjusted odds ratio high relative to low, 15.12) and presence of chronic conditions (adjusted odds ratio 1 relative to 0, 1.78; relative to 2 or more, 3.38) are the strongest predictors of ANY PDI events. CONCLUSIONS: Our findings suggest that the patient population served, rather than hospital category, best predicts measured quality, underscoring the need for robust risk adjustment when incentivizing quality or comparing.


Abstract only. Full-text article is available only through licensed access provided by the publisher. Published in Pediatrics, 131(2), 304-311. DOI: 10.1542/peds.2012-1089 Members of the USF System may access the full-text of the article through the authenticated link provided.




American Academy of Pediatrics

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.