# Presentation: 493904

## OUTLINE FOR TODAY’S TALK

**Quality of Care: Definitions**
**Who Uses Quality Assessment Information **
**Quality Measurement Methods**
**Challenges for Measuring Quality for Children**
**Quality Improvement**
**Summary**

## INSTITUTE OF MEDICINE DEFINITION OF QUALITY (1990) 

**The degree to which health services for individuals and populations **
**       ***** increase the likelihood of desired **
**          ****health outcomes and**
**       ***** are consistent with current **
**          ****professional knowledge**

## STEPS IN DEFINING QUALITY

## POTENTIAL USERS OF QUALITY ASSESSMENT INFORMATION

**Consumers**
**CHIP administrators**
**Clinicians**
**Health Plans**
**Policy makers**
**Researchers**

## CONCEPTUAL FRAMEWORK

## Health Care Organization Characteristics
Ratio of hospital beds to covered population
Weekend and night hours
Accessible to transportation
Provider Characteristics
Pediatric subspecialists
Case managers
Translators

**Ratio of hospital beds to covered population**
**Weekend and night hours**
**Accessible to transportation**
**Provider Characteristics**
**Pediatric subspecialists**
**Case managers**
**Translators**

**STRUCTURAL MEASURES**

## CONCEPTUAL FRAMEWORK

## TECHNICAL PROCESS: ADHERENCE TO PROFESSIONAL STANDARDS OF CARE 

**Process Quality Indicators Describe a Process of Care That Should Occur for a Particular Type of Patient or Clinical Circumstance **

## INDICATORS FOR CHILDREN

**Well Child Care**
**The child’s weight should be measured at least four times during the first year of life.  This information must either be plotted on a growth curve or recorded with the age/gender percentile.  **
**Sickle Cell Disease**
**Children with a positive sickle cell screen or suspected of being positive for sickle cell disease should be placed on daily penicillin prophylaxis from at least six months of age until at least five years of age.**

## PROCESS QUALITY INDICATORS

**Sources: Research Literature, Statements of Professional Medical Organizations, Expert Panel**
**Best If Leads to Better Outcomes**
**Performance of Plans/clinicians Is Measured by Rates of Adherence to the Indicator**
**Not Looking for 100% Adherence**
**Generally Aim to Cover a Few Markers of Clinical Care for a Condition Rather Than All Aspects of Care: Canary**

## CONCEPTUAL FRAMEWORK

## Waiting Time to Get an Appointment
The Way Questions Are Answered
Ability to Get All the Care a Parent Feels the Child Needs
Overall

**The Way Questions Are Answered**
**Ability to Get All the Care a Parent Feels the Child Needs**
**Overall**

**SATISFACTION/CONSUMER ASSESSMENT**

## CONCEPTUAL FRAMEWORK

## SOURCES OF INFORMATION ON QUALITY

**Administrative Data**
**Follow-up for ear infection**
**Was lab test done**
**Medical Record**
**Was the ear examined, what did it look like **
**What are results of lab test, was it addressed**
**Patient Survey**
**What happened (or what they remember)**
**What they know (following counseling)**
**Satisfaction**
**Registries**
**Applications, Reports to CHIP**

## CHALLENGES IN QUALITY ASSESSMENT FOR CHILDREN

**Children Tend to Be Healthy: Low Incidence and Prevalence of Disease  **
**Much of Care Is Preventive**
**Long Term Outcomes: **
**Assign responsibility, system change**
**Limited Research Base**
**Age-Specific and Developmentally Appropriate Indicators **
**Confidentiality**

## QUALITY IMPROVEMENT

**Traditional: Outliers, “Bad Apples”**
**Focus on individual incompetence or irresponsibility**
**Continuous Quality Improvement**
**Raise the average level of quality by improve quality of all clinicians**
**Focus on systematic problems**
**Interdisciplinary teams**
**Example:  medication errors**

## SUMMARY

**Quality Assessment Can **
**Help screen out bad providers**
**Help with improving all providers**
**Show effects of changes or variations**
**Need to Implement Systems Now**
**Easier if plan new program and new system together**
**Will want to compare before and after**
**Models and indicators are available (e.g., HEDIS)**
**Opportunity for creativity**