Objective To investigate trends in the monitored single-disease quality-control indicators for pediatric community-acquired pneumonia (CAP) across different categories of medical institutions in Shanghai from 2020 to 2025.
Methods Six-year monitoring data on 10 single-disease quality-control indicators for pediatric CAP were collected from 102 medical institutions in Shanghai between January 1, 2020, and December 31, 2025. The indicators included the number of pediatric CAP discharges, proportion of severe CAP cases among hospitalized patients, severity assessment rate, antibiotic use rate, mechanical ventilation rate, blood transfusion rate, in-hospital mortality rate, average length of stay, average hospitalization cost per case, and average medication cost per case. The 102 medical institutions were stratified into four categories: category A (n=44, tertiary general hospitals), category B (n=35, secondary general hospitals), category C (n=3, tertiary children′s specialty hospitals), and category D (n=20, other medical institutions, including traditional Chinese medicine hospitals, maternal and child health institutions, infectious disease hospitals, and public health institutions). Six-year monitoring data for the four categories were extracted from the Shanghai Medical Service Monitoring and Evaluation System, and their annual changes were analyzed. Proportion indicators, including the proportion of severe CAP cases among hospitalized patients and the severity assessment rate, were expressed as percentages and analyzed using the Cochran-Armitage trend test. Quantitative indicators, including average length of stay, average hospitalization cost per case, and average medication cost per case, were expressed as means and analyzed descriptively for annual changes.
Results ① From 2020 to 2025, a total of 183 307 pediatric CAP discharge cases were included from 102 medical institutions in Shanghai. Patients from categories A, B, C, and D institutions accounted for 49.25% (90 279/183 307), 16.89% (30 961/183 307), 33.08% (60 632/183 307), and 0.78% (1 435/183 307), respectively. The proportion of severe CAP cases among hospitalized patients was highest in category C institutions. This proportion decreased significantly in categories A, B, and C institutions (Z=-8.93, -2.84, and -4.64, respectively; all P<0.05). ② The severity assessment rate improved overall across all four categories institutions, with statistically significant annual trends (Z=21.61, 21.76, 25.76, and 10.73, respectively; all P<0.001). The antibiotic use rate decreased in category C institutions but increased in categories B and D, with statistically significant annual trends (Z=-36.84, 19.36, and 15.51, respectively; all P<0.001). ③ The mechanical ventilation rate was generally higher in category C institutions than in the other three categories institutions but showed a decreasing trend (Z=-4.40, P<0.001). Category A institutions showed an increase followed by a decrease (Z=-3.08, P = 0.002). Blood transfusion rates decreased in categories A and C institutions (Z=-9.56 and -21.28, respectively; both P<0.001). ④ In-hospital mortality remained low overall across the four categories and decreased in categories A, B, and C institutions (Z=-17.64, -1.97, and -4.62, respectively; all P<0.05). Average length of stay shortened overall, with more pronounced reductions in categories A and C institutions. Average hospitalization cost per case and average medication cost per case generally decreased in categories A and C institutions, whereas more marked year-to-year fluctuations were observed in categories B and D institutions.
Conclusions From 2020 to 2025, the monitored single-disease quality-control indicators for pediatric CAP in Shanghai showed an overall improving trend, and a relatively clear stratified admission pattern was observed. Category A institutions undertook the largest share of pediatric CAP admissions, whereas category C institutions played an important role in the management of severe pediatric CAP. Future quality-control efforts should consider the functional roles of different medical institutions, improve the stratified quality-control and information technology-enabled management systems for pediatric CAP, and further enhance the quality and management of regional pediatric CAP care.