Checklists and other quality measures are critical in protecting patients and improving the quality of health care. Unfortunately, many physicians and other clinicians find the burden of documentation overwhelming.
David Blumenthal and J. Michael McGinnis argue that part of the problem is that we have too many measures.
Not only are many measures imperfect, but they are proliferating at an astonishing rate, increasing the burden and blurring the ability to focus on issues most important to better health and health care. Measures of the same phenomenon also vary in specification and application, leading to confusion and inefficiency that make health care more expensive and undermine the very purpose of measurement, namely, to facilitate improvement. Not uncommonly, a health care organization delivering primary care to a typical population is asked to report and collect hundreds of measures aimed at dozens of conditions.
With Kelly Kelleher, a pediatrician at Nationwide Children’s Hospital, I have been working with a group of child health experts to develop a parsimonious set of core quality and outcome measures for children’s health care. We describe this effort in JAMA Pediatrics. We’re part of a larger National Academy of Medicine effort. They have proposed a core measure set for adults. We argue, however, that because children are different, we need a distinctively pediatric set of quality and outcome measures.
We need a measure set for children because the goals of children’s health care are different from that of adults, children face different health risks, and the context of children’s health care is different.
The goal of health care—well-being—has a different meaning across the life span. For children, it is building the physical, cognitive, and social foundations for adult capabilities in addition to enhancing their current state. The specific health needs of children can change rapidly as they pass through developmental stages. Thus, a pediatric measure set must find a careful compromise that is sensitive to development without excessively expanding the number of measures.
Similarly, children face different health risks. Because children are mostly healthy, subclinical precursor states of adult health problems get insufficient attention. Preventive care is therefore underemphasized, leading to health problems in adulthood. For example, adolescents being overweight and obese is strongly associated with adult cardiovascular mortality.
Finally, children’s risks are different because many of the diseases and risks for children are environmental or neighborhood-influenced. Children are more sensitive to socioenvironmental factors and depend more on support for their health and care than adults. Thus, detailed measures that capture the socioenvironmental circumstances in the community are essential.
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