Stories about: quality of care

Embracing the future of pediatric quality measurement

Pediatric quality of care researchWhile 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.

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Population health: Bringing together medical, public health and payer communities

The people who deliver care are starting to think in terms of population health.
The people who deliver care are starting to think in terms of population health.
A growing number of health care professionals are looking at their patients not just as individuals with unique concerns but also as members of larger groups with common problems and needs. This broader, population-based framework could lead to better health outcomes for more people, according to Jonathan Finkelstein, MD, MPH of Boston Children’s Hospital.

“The health care system is changing from one that’s more reactive to illness—you come see the doctor when you’re not well—to one that’s more responsible for the promotion of health for defined groups of people,” he explains. While individual patients will always be treated as, well, individuals, the concept of population health can help providers “figure out the most appropriate services within a set of limited resources for specific groups.”

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Being PRUDENT about transfusions

What time is the right time to give a transfusion? Doctors at Boston Children's are turning a fresh eye on transfusion guidelines for children. (@alviseni/Flickr)

Cancer. Trauma. Sickle cell disease. Surgery. There are many reasons why a child might need a blood transfusion, but they all share a common theme: the need to replace blood or blood products (e.g., red blood cells, platelets) that have been lost or consumed, or make up for defects that keep the body from producing them in adequate amounts.

And though transfusions can be life saving, they come with risks, such as iron overload, inflammation or disease (a very low risk, thanks to improved screening tests). And blood products are expensive and scarce—another reason to be prudent about transfusions.

“There’s little science behind physicians’ current practices when deciding when to transfuse a patient,” says Jenifer Lightdale, MD, MPH, of Boston Children’s Hospital’s Division of Gastroenterology and Nutrition. “Many doctors use criteria their mentors passed down to them, which their mentors passed down to them, and so on. But ideally, the decision should be based on evidence, not tradition.”

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