Quality Measurements in Pediatrics

Health Equity and Quality of Care Assessment: A Continuing Challenge

“…However, it is not clear whether the assessed quality of care for 1 condition (such as the hematology clinic managing sickle cell disease) can be applied to other providers (such as obstetricians and neonatologists managing high-risk pregnancies). 7 It is more likely that these assessments apply specifically to the conditions measured, unless there are explicit studies to suggest otherwise.…”

Challenges to Measuring the Quality of Low-Risk Newborns

“…As with other composite measures in neonatology, these specific complications have both different short-and long-term outcomes in infants (eg, a transfer of a hypoglycemic infant is very different from that of an infant with sepsis or an infant who has died), and these various measures likely assess different aspects of the overall care delivered to laboring women and their newly delivered infant. 4,5 As a result, hospitals with the same rate of "severe complications" could trigger this metric through an unusually high rate of neonatal death, or a high rate of neonatal transfer. The root causes for such a difference are likely to be substantially different.…”

“…The paucity of metrics makes such measurement very difficult, particularly when 1 single measure may only provide limited insights into the overall quality of care provided to lowrisk populations. 4 The relative rareness of these outcomes in these low-risk populations, however, provides an additional barrier toward understanding the drivers of such variation, particularly when measures of health care use are combined with more tangible measures of illness severity. Continued development and understanding of the drivers of improved performance in measures of the low-risk population will be critical to improving the value of health care in the United States.…”

Regarding “Implicit Review Instrument to Evaluate Quality of Care Delivered by Physicians to Children in Emergency Departments”

“…In truth, stakeholders would like a quality measure that measures the nebulous construct, “quality of care.” The quality “black box,” though, resists easy measurement, primarily because there are so many different dimensions and aspects of clinical care that require measurement. As a result, quality measurements can be divided into two groups, depending on how they assess this construct (Lorch , ):…”

“…The quality "black box," though, resists easy measurement, primarily because there are so many different dimensions and aspects of clinical care that require measurement. As a result, quality measurements can be divided into two groups, depending on how they assess this construct (Lorch 2013(Lorch , 2017a • Measures that broadly assess the quality of an organization, but provide limited data about a specific dimension of care or topic area. Observed improvements in these "broad" measures should impact numerous dimensions of clinical practice and outcomes, but the specific size of this improvement for a specific dimension may be difficult to assess a priori.…”