Developing and Validating a Pediatric Potentially Avoidable Transfer Quality Metric.

This study aimed to evaluate a quality metric that identifies pediatric potentially avoidable transfers from diagnosis and procedure codes. Using physician medical record review as the gold standard, the following steps were used: (1) develop the initial metric definition, (2) estimate initial metric definition operating characteristics, (3) refine this definition to optimize the c-statistic, and (4) validate this optimized metric definition using a separate sample. The initial metric using Sample A patient transfers had a c-statistic of 0.63 (95% confidence interval = 0.53-0.73). Following 22 revisions, the optimized metric definition was a transfer discharged within 24 hours that did not receive any of a select list of 60 268 specialized diagnoses or procedures. The optimized metric on Sample B demonstrated a sensitivity of 80.6%, specificity of 85.7%, and c-statistic of 0.83 (95% confidence interval = 0.75-0.91). The quality metric developed and validated in this study demonstrated satisfactory operating characteristics, providing a feasible means to measure this important outcome.

Young children's fast mapping and generalization of words, facts, and pictograms.

To test general and specific processes of symbol learning, 4- and 5-year-old children learned three kinds of abstract associates for novel objects: words, facts, and pictograms. To test fast mapping (i.e., one-trial learning) and subsequent learning, comprehension was tested after each of four exposures. Production was also tested, as was children's tendency to generalize learned items to new objects in the same taxon. To test for a bias toward mutually exclusive associations, children learned either one-to-one or many-to-many mappings. In Experiment 1, children learned words, facts (with or without incidental novel words), or pictograms. In Experiment 2, children learned words or pictograms. In both of these experiments, children learned words slower than facts and pictograms. Pictograms and facts were generalized more systematically than words, but only in Experiment 1. Children learned one-to-one mappings faster only in Experiment 2, when cognitive load was increased. In Experiment 3, 3- and 4-year-olds were taught facts (with novel words), words, and pictograms. Children learned facts faster than words; however, they remembered all items equally well a week later. The results suggest that word learning follows non-specialized memory and associative learning processes.