The Challenges of Addressing Pediatric Quality Measurement Gaps

摘要

* Abbreviation: EHR a?? : electronic health record In this issue of Pediatrics , the article by House et al1 provides a summary of pediatric quality measures currently available in national databases as well as an assessment of how comprehensively these measures represent common pediatric issues. The authors found a preponderance of process measures that have not been outcome-validated. They also found a dearth of measures for some of the most common and/or costly conditions, and relatively few health outcome measures. These findings are not unexpected and are unlikely to change without a paradigm shift in how quality measures are developed and implemented in health care systems across the United States. The first step in quality measure development is to review the evidence and/or clinical practice guidelines related to the topic under consideration.2 Guidelines represent a??state-of-the-arta?? thinking about how conditions should be diagnosed, treated, and, for chronic conditions, managed over time. Thus, when they exist for a given condition, clinical practice guidelines are usually the main source used to develop quality measures. When guideline recommendations are based on low-quality a?| Address correspondence to Rita Mangione-Smith, MD, MPH, Seattle Childrena??s Research Institute, Center for Child Health, Behavior, and Development, 2001 Eighth Avenue, Suite 400, Seattle, WA 98121. E-mail: rita.mangione-smith{at}seattlechildrens.org