Quality of Care for Common Pediatric Respiratory Infections: Shortfalls and Improvements

Keith J. Mann; Jane F. Knapp


Pediatr Health. 2009;3(3):261-269. 

In This Article

Abstract and Introduction


Respiratory infections are common in children and are responsible for serious morbidity, significant mortality and large healthcare expenditures worldwide. Three of the most common respiratory infections in children are bronchiolitis, croup and community-acquired pneumonia. Despite advances in the care of children with respiratory infections, shortfalls in the safe, timely, effective, efficient, equitable and patient-centered domains of quality remain. This article reviews and summarizes the advances that have improved the quality of care for bronchiolitis, croup and community-acquired pneumonia during the last 5 years and identifies shortfalls that must be addressed. In this article, we also discuss the future of the quality of care for pediatric respiratory infections.


The Institute of Medicine defines quality as "The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.[101]" The six domains of quality have been defined as safe, timely, effective, efficient, equitable and patient-centered care.

Pediatricians have learned a tremendous amount regarding the quality of care for common respiratory illness over the past several decades; however, that knowledge has not always translated into clinical practice. This discrepancy reinforces what we know to be true; there remains a gap between evidence-based knowledge and evidence-based practice.

To assess the quality of care for common respiratory infections in pediatrics, we will summarize current therapeutic practice and highlight recent developments for bronchiolitis, croup, and community-acquired pneumonia (CAP). These infections are common in children, and each has an evidence base from which to make diagnostic and treatment decisions. This discussion will review recent advances as well as current shortfalls in quality of care.

Our search for advances and shortfalls in quality focused on clinical practice guidelines (CPGs) derived from graded studies using standards of evidence-based medicine as well as expert panels, systematic reviews, meta-analyses, randomized, controlled trials (RCTs) and policy statements also derived from graded evidence and/or developed by expert panels published since 2003. These articles were reviewed and we cite pre-2003 literature in this article when relevant.


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