The Challenges of Addressing Pediatric Quality Measurement Gaps

Quality care for children and young people with complex and integrated care needs: A discussion on nursing-sensitive indicators

This paper highlights the need for nursing-sensitive indicators tailored to children and young people with complex and integrated care needs. While nursing plays a pivotal role in influencing care quality for this population, current measures predominantly focus on adult populations, creating gaps that hinder the evaluation of nursing contributions across diverse settings such as acute, community, and home care. We examine the importance of quality care measurement for children and young people with complex and integrated care needs and highlight deficiencies in international measurement systems. The discussion highlights the multidimensional care needs of this vulnerable population and advocates for nursing-sensitive indicators that capture broader outcomes including physical health, functional outcomes, family experience, and family well-being. Also highlighted is, the weak evidence linking process indicators to improved patient outcomes, a focus on negative outcomes, such as mortality, and the lack of theoretical foundations for nursing-sensitive indicators. There is a lack of consensus on what components to measure, definitions of indicators, and appropriate methodologies for the development of nursing sensitive indicators. Donabedian's (1988) structures, processes, and outcomes framework is discussed as well as an overview of adaptations used to improve the quality of indicator sets in a variety of settings. By situating the discussion within the context of children's and young people's nursing, this paper aims to direct future research towards the development of comprehensive indicators that capture the full contribution of nursing to the care of children and young people with complex and integrated care needs. Ultimately, this paper advocates for a standardised, holistic approach to nursing-sensitive indicators for this vulnerable population to improve care quality and overall health and wellbeing for children, young people, and their families.

Pediatric quality measures: The leap from process to outcomes

Value-based reimbursement arrangements tie financial incentives to achieving quality measures to ensure savings are not from withholding care. For patients and their families, the delivery of high-quality care is simply the expectation. Defining and measuring pediatric quality, however, is not standardized which has led to a large proliferation of metrics across multiple stakeholders. The majority of these measures are process rather than outcomes metrics often chosen for the ease at which the data can be obtained. In order to drive greater value, outcomes measures should be preferentially selected. However, measuring outcomes in children presents multiple unique challenges. Compared to adults, children are generally healthier, their outcomes may take more time to manifest, and their clinical variability is greater. Another challenge is the amount of healthcare data being generated by providers, provider networks, payors, government agencies, and many others. This should help in understanding pediatric quality outcomes, but the massive volume of data requires new analytic tools. Artificial intelligence techniques such as machine learning offer faster, more precise, and larger scale evaluation of quality outcomes. Its implementation necessitates identifying expertise in the way of data scientists as well as additional infrastructure components to evaluate data governance, security, regulatory compliance, and ethics. Despite these prerequisites, much progress is being made in outcome insights that drive value benefiting children and families.

Improving the quality of quality metrics in neonatology

This article examines approaches for improving the efficiency and effectiveness of quality metrics currently in use in neonatal care. Desirable characteristics of quality metrics are discussed, the criteria and process for their development are presented, and the uses and limitations of current neonatal outcome and process metrics are explored together with approaches for improving metric performance. Discussion includes enhancing quality metrics through optimizing improvement readiness, sustaining improvements once achieved, and use of improvement science methods to improve metric validity.

Validation of a Parent-Reported Hospital-to-Home Transition Experience Measure

OBJECTIVES

The Pediatric Transition Experience Measure (P-TEM) is an 8-item, parent-reported measure that globally assesses hospital-to-home transition quality from discharge through follow-up. Our goal was to examine the convergent validity of the P-TEM with existing, validated process and outcome measures of pediatric hospital-to-home transitions.

METHODS

This was a prospective, cohort study of English-speaking parents and legal guardians who completed the P-TEM after their children's discharge from a tertiary children's hospital between January 2016 and October 2016. By using data from 3 surveys, we assessed convergent validity by examining associations between total and domain-specific P-TEM scores (0-100 scale) and 4 pediatric hospital-to-home transition validation measures: (1) Child Hospital Consumer Assessment of Healthcare Providers and Systems Discharge Composite, (2) Center of Excellence on Quality of Care Measures for Children With Complex Needs parent-reported transition measures, (3) change in health-related quality of life from admission to postdischarge, and (4) 30-day emergency department revisits or readmissions.

RESULTS

P-TEM total scores were 7.5 points (95% confidence interval: 4.6 to 10.4) higher for participants with top-box responses on the Child Hospital Consumer Assessment of Healthcare Providers and Systems Discharge Composite compared with those of participants with lower Discharge Composite scores. Participants with highet P-TEM scores (ie, top-box responses) had 6.3-points-greater improvement (95% confidence interval: 2.8 to 9.8) in health-related quality of life compared with participants who reported lower P-TEM scores. P-TEM scores were not significantly associated with 7- or 30-day reuse.

CONCLUSIONS

The P-TEM demonstrated convergent validity with existing hospital-to-home process and outcome validation measures in a population of hospitalized children.

Pediatric Quality Metrics Related to Quality and Cost

The institution of pediatric quality in health care has grown in the past decade but continues to evolve. Children's health care emphasizes the importance of maintenance of health and prevention of illness, which can be measured based on immunization rates, routine or scheduled well care, and early intervention. Pediatric quality measures and indicators have become the basis for payment of services and a true goal to value. Designing processes such as pay-for-performance models, volume-based care, and coordination of care assist in assuring that children receive high-quality health care.