Improving quality and safety, and doing it in a transparent way, is one of the most important issues in health care today. Children's Hospital Boston is playing a national role, both in defining pediatric quality standards and by demystifying how quality and safety is measured and making that information accessible to families.
Quality and safety for families
Children's introduced a new Quality and Safety Web site in May, as part of the new Children's external Web site, childrenshospital.org. "Our goal is to present quality and safety data that is clear and understandable to parents," says Kathy J. Jenkins, MD, MPH, senior vice president of the Program for Patient Safety and Quality (PPSQ). "Many hospitals report quality and safety data, but very few make it comprehensible to patients and families."
The central area of the Quality and Safety Web site, Our Report Card, outlines key Children's quality and safety measures. Measures are categorized according to the six quality principles of the Institute of Medicine, which state that care should be safe, effective, patient-centered, timely, efficient and equitable. The Report Card describes each measure, explains why it is important and tells how Children's tracks the measure. It also shows how Children's compares with other children's hospitals nationwide and what Children's is doing to make improvements. Easy-to-understand charts with "mouse-over" functions portray and explain the data.
For example, one measure is central line bloodstream infections (CLBSI) in Children's intensive care units (ICUs). The Report Card explains that CLBSIs are believed to be the cause of nearly one- third of all infection-related deaths in U.S. hospitals and that they add an estimated $42,000 to the medical bills of patients who get them. Accompanying charts show that Children's overall CLBSI rate dropped below the average reported by the CDC's National Healthcare Safety Network three years ago. In fact, as a result of a major PPSQ effort, the rate of CLBSIs in Children's medical/surgical ICU is zero.
Other quality and safety measures on the Web site include:
- length of stay in the Emergency Department
- overall length of stay and readmission rates
- serious preventable adverse events
- immunization rates
- pain management
- diabetes care
- lung function in patients with cystic fibrosis
- asthma care
- patient satisfaction
- equitable nursing care
In addition, each of the hospital's national care centers (cardiovascular, neurosciences, cancer and blood diseases, orthopedics and transplant) reports quality, safety and outcomes measures specific to that clinical service to PPSQ. New institution-wide and service-specific measures are being added every few months.
Setting national standards for pediatric care
Children's continues to play a leadership role in setting national quality standards for pediatrics. Research studies are funded annually by the PPSQ. One recent study reviewed adolescent eating disorder programs across 11 hospitals nationwide, with the goal of establishing consensus on a national set of quality improvement standards for eating disorders. Another study assessed the effectiveness of a new web tool, eDMC, for tracking status and outcomes for children with ADHD. Paper questionnaires have historically made it difficult to collect and synthesize data on this population. The web-based system allows parents and teachers to easily record their observations; then doctors can track reports to find relationships between medications/treatments and the child's behavior scores. More than 1,000 patients were enrolled. The rate of questionnaire submission increased from 30 percent to 60 percent. Clinicians report that the tool saves time and improves their decision-making ability.
On the national front, Children's recently received an $8 million grant from the U.S. Department of Health and Human Services. The grant funds the Children's Center of Excellence for Quality Measurement to improve the way health care is delivered to children across the United States. This new center will be one of the first in the country to respond to the Child Health Insurance Program Reauthorization Act (CHIPRA). In 2009, CHIPRA called for a national Pediatric Quality Measures Program to convene experts, solicit public input and build infrastructure to provide measures that can significantly advance the quality of pediatric healthcare. Children's will be one of seven sites around the country working to develop and test new quality measures. They will be using state-of-the art technology and will be partnering with local agencies and parents and patients.
"Developing measures to track quality is crucial to ensure excellent care for all children," says the principal investigator, Mark A. Schuster, MD, PhD, chief of General Pediatrics. "There are many measures available for adult care, but very few for pediatrics," he points out. CHIPRA has declared that it's time for pediatrics to catch up. We are very excited to be a part of this important process."