Despite many recent attempts to improve the quality of child health services, numerous gaps remain. In fact, widespread improvement in the quality of health services for children is hampered by significant barriers.
A recent study by Denise Dougherty, Ph.D., of the Agency for Healthcare Research and Quality, and her colleagues at Massachusetts General Medical School found that several quality improvement (QI) methods have demonstrated effectiveness. These include reminder systems for office-based preventive services that substantially improved physicians' immunization, screening, and pediatric counseling practices. Successful inpatient pathways (documenting processes of care) or guidelines range from those that improved the quality of pediatric emergency care to those that increased the use of anti-inflammatory medications from 2 percent to 25 percent among children with asthma.
These findings come from a review of published literature from 1985 to 1997 on QI initiatives. In addition, Dr. Dougherty and her colleagues interviewed experts experienced in QI for child health services. Interviews with experts revealed that barriers to QI for children were similar to those for adults, despite the experts' perceptions that pediatric QI is more difficult. The good news is that the number of pediatric QI studies being reported in the literature has grown in the past few years. Limitations include the following: most of the studies reviewed by the researchers involved children under 5 years of age; and for most QI interventions assessed, evidence was insufficient to adequately inform clinicians and administrators. Also, reportedly successful QI initiatives more commonly described improvement in administrative measures such as rate of hospitalization or length of stay rather than functional status or quality of life.
Efforts in child QI need to move beyond administrative process measures and take on child health outcomes such as quality of life and optimal development, suggest the researchers. Their study provides a much-needed baseline for pediatric care improvement efforts, notes AHRQ Deputy Director Lisa Simpson, M.B., B.Ch., M.P.H., F.A.A.P., in an accompanying commentary.
More details are in "A report card on quality improvement for children's health care," by Timothy G. Ferris, M.D., M.P.H., Dr. Dougherty, David Blumenthal, M.D., M.P.P., and James M. Perrin, M.D.; and "Quality of Care: Time to make the grade," by Dr. Simpson, in the January 2001 Pediatrics 107(1), pp. 143-155, 171.
Reprints (AHRQ Publication No. 01-R020) are available from the AHRQ Publications Clearinghouse and AHRQ InstantFAX.