While studying quality of care in the 1990s, Mark Schuster, MD, PhD found that few studies on pediatric quality had been conducted. The typical explanation that he was given was that the federal government wasn’t funding research into quality measures because children on Medicaid don’t drive federal health-care costs nearly as much as adults on Medicaid and Medicare do.
But Schuster, chief of General Pediatrics at Boston Children’s Hospital and William Berenberg Professor of Pediatrics at Harvard Medical School, believes there have been other challenges in measuring care quality in children. In an acceptance speech upon receiving the 2014 Douglas K. Richardson Award for Perinatal and Pediatric Healthcare Research, published today in the journal Pediatrics (PDF), Schuster points to factors including the relative rarity of many pediatric conditions and that many of the benefits of excellent pediatric care are not observed until adulthood.
Schuster has been working to overcome these challenges. He’s currently leading the Center of Excellence for Pediatric Quality Measurement (CEPQM) at Boston Children’s Hospital—one of seven centers of excellence established in 2011 and funded by the federal government to develop various pediatric quality measures, from newborn care to mental health treatment. Schuster’s team is tasked with developing and testing national pediatric quality measures, the first three of which recently received endorsement from the National Quality Forum: parent or guardian surveys of their child’s inpatient care (known as Child HCAHPS), and pediatric readmission rates for all conditions and for lower respiratory infections.
The federal Pediatric Quality Measures Program, which oversees the centers of excellence, is led by the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare and Medicaid Services (CMS). Schuster writes in Pediatrics that this program is a watershed:
This represents the largest investment in pediatric quality measurement to date, and if all goes well, it will provide a major leap forward in our ability to measure pediatric quality around the country.
What will this leap forward entail? Schuster and his team are working towards a future where national quality measures specifically designed for children will be routine, automated, affordable, publicly available — and fully embraced by health care professionals. As he puts it:
If we are succeeding in creating an effective system to measure quality, all of us in health care will embrace the idea of measurement. No one likes being measured, but we need to move measurement past making us feel like we’re being beaten with a stick to a future in which we consider it a tool that is critical to our efforts to provide even better care.
Schuster doesn’t expect this future to arrive overnight. He’s realistic about the challenges and detours ahead, but he’s also confident the payoff will be well worth the time and collective effort involved:
We are in a period of transition. Pediatric quality measurement is still young. Some things we try will work, and some won’t. This can be hard and frustrating. If we do it right, though, we can make a real difference.