Measuring quality of pediatric care: where we've been and where we're going.

Abstract

It is a special privilege to receive an award that honors Doug Richardson, who was my attending physician during residency. He showed extraordinary dedication to his patients, his colleagues, and his trainees. I thought I would share my thoughts on quality measurement here not only because the care that Doug gave was of the highest quality but also because he believed in applying measurement to the delivery of health care1,2 and he encouraged me to view health services research as fundamental to improving children’s health. First, I will discuss why we measure quality. Then I will describe where the field was 2 decades ago when I first started working in it. I will then move on to where we are now, and finally, where I hope to see us go in the future. So, to begin, what do we use quality measurement for? First, quality measurement can help us improve quality. If we don’t know how we’re doing, we don’t know where we need to do better. Study after study has shown that measuring quality can lead to improving it.3–5 Quality measurement can also make us more accountable, as in public reporting and pay-for-performance, which are becoming more common around the country.5 Quality measurement can inform accreditation and certification processes.5 The Joint Commission, for example, has incorporated quality measures into its accreditation process and has found evidence suggestive that these measures might be leading to improvement.6 And quality measurement can answer critical research questions. It can elucidate disparities by race, ethnicity, income, and geography,7 and it can document the effects of policy changes and innovations, such as the development of Accountable Care Organizations. Back when I was first starting out, I worked on an analysis of published quality-of-care studies for … Address correspondence to Mark A. Schuster, MD, PhD, Division of General Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail: mark.schuster{at}childrens.harvard.edu