Improving Emergency Medical Services for Children Through Outcomes Research: An Interdisciplinary Approach

Abstract

The emergency department (ED) is an important and frequent site for pediatric care. Children and adolescents in the United States make 30 to 35 million ED visits annually; yet, with a few notable exceptions, little is known about the outcomes attributable to the care of children in the ED or the contribution of the ED to processes of care for US children. Most research in pediatric emergency medicine (PEM) focuses on the accuracy of diagnosis, acute changes in patient status, rates of relapse, visit charges, or surveys of PEM practitioners about processes of care. Measures are needed that enable investigators to assess the contribution of pediatric ED care to patient and parental satisfaction as well as to the child’s overall quality of life and family functioning, in addition to more immediate health outcomes. Moreover, the field needs measures that describe not only the medical or technical aspects of care but also information transfer and style of physician-patient interaction to better characterize the quality of pediatric ED care and its contribution to children’s health. Although many outcomes and measures used in pediatric research in general and in PEM research in particular originated in work with adult patients, it is not possible to simply use measures developed for adults, since processes of care as well as outcomes of interest are frequently different for children. Furthermore, pediatric outcome measures must address children at various developmental stages and must also address their adult caretakers. There is a need to assess the utility of measures that tease apart elements of the ED visit as well as to identify measures that can be standardized for use across sites as well as across visits.