Ohio — Targeted Issue

Description

Assessing the quality of medical care and identifying opportunities for improvement of care is an important responsibility of medical professionals, as well as all health care facilities. Though children account for 20% of emergency care visits nationally, few measures have been defined for assessing the emergency care of pediatric patients. This toolkit features the work of Evaline Alessandrini, MD, and her EMSC Targeted Issues project "Defining Quality Performance Measures for Pediatric Emergency Care." Her project seeks to improve pediatric emergency care through the consensus identification of pediatric emergency care performance measures and associated elements of documentation. Providing a framework for the measurement of pediatric emergency care will facilitate national benchmarking as well as an opportunity for development of risk adjustment processes to facilitate better pediatric emergency care research.

Author(s)/Presenter(s)

Alessandrini E, Varadarajan K, Alpern ER, Gorelick MH, Shaw K, Ruddy RM, Chamberlain JM; Pediatric Emergency Care Applied Research Network

Abstract/Description

Objectives: The Institute of Medicine (IOM) has recommended the development of national standards for the measurement of emergency care performance. The authors undertook this study with the goals of enumerating and categorizing existing performance measures relevant to pediatric emergency care.

Methods: Potential performance measures were identified through a survey of 1) the peer-reviewed literature, 2) websites of organizations and societies pertaining to quality improvement, and 3) emergency department (ED) directors. Performance measures were enumerated and categorized, using consensus methods, on three dimensions: 1) the IOM quality domains; 2) Donabedian's structure/process/outcome framework; and 3) general, cross-cutting, or disease-specific measures.

Results: A total of 405 performance measures were found for potential use for pediatric emergency care. When categorized by IOM domain, nearly half of the measures were related to effectiveness, while only 6% of measures addressed patient-centeredness. In the Donabedian dimension, 67% of measures were categorized as process measures, with 29% outcome and 4% structure measures. Finally, 31% of measures were general measures relevant to every ED visit. Although 225 measures (55%) were disease-specific, the majority (56%) of these measures related to only five common conditions.

Conclusions: A wide range of performance measures relevant to pediatric emergency care are available. However, measures lack a systematic and comprehensive approach to evaluate the quality of care provided.