Health Care Quality Measures Research Articles

P-334 Are measurements of patient-centeredness of endometriosis care and quality of life in women with endometriosis associated?

Abstract Study question To examine the hypothesis that experiences with patient-centred endometriosis care are associated with the endometriosis-specific quality of life dimensions ‘emotional wellbeing’ and ‘social support’. Summary answer Positive associations were found between experienced patient-centeredness of care and the quality of life domains ‘emotional well-being’ and ‘social support’. What is known already Women with endometriosis have lower quality of life. Furthermore, research showed that the patient-centeredness of endometriosis care could still be improved. The quality of the provided endometriosis care might impact women’s quality of life, as demonstrated in the field of fertility care. A previous explorative study identified associations between patient-centred endometriosis care and two in five dimensions of endometriosis-specific quality of life (i.e. ‘emotional well-being’ and ‘social support’) but concluded that a more focussed and adequately powered study was needed. Study design, size, duration A secondary regression analysis of two cross-sectional cohort studies was performed. Both studies investigated patient-centeredness of endometriosis care and endometriosis-specific quality of life using respectively the ENDOCARE questionnaire (ECQ) and the Endometriosis Health Profile 30 (EHP-30). In total the data from 300 women was eligible for analysis, exceeding the, according to our power calculation, required sample size of 200 women. Participants/materials, setting, methods The participating women all had surgically proven endometriosis and were recruited by one secondary and two tertiary endometriosis clinics in the Netherlands. The regression analysis focused on the previously found association between the ten dimensions of the ECQ and the EHP-30 domains ‘emotional well-being’ and ‘social support’ rather than all five EHP-30 domains. After the Bonferroni correction to limit type I errors, the adjusted p-value was 0.003 (0.05/20). Main results and the role of chance The participating women had a mean age of 35.7 years and had predominantly been diagnosed with moderate to severe (68.6%). Regarding the EHP-30 domain ‘emotional well-being’, an association was found with the following five patient-centeredness dimensions: ‘respect for patients’ values, preferences and expressed needs’ (p = 0.046, Beta=0.159), ‘coordination and integration of care’ (p = 0.013, Beta=0.193), ‘information, communication and integration of care’ (p = 0.010, Beta=0.258), ‘emotional support and alleviation of fear and anxiety’ (p = 0.010, Beta=0.178), and ‘continuity and transition’ (p = 0.015, Beta=0.179). None of the associations between the EHP-30 domain ‘emotional well-being’ and a dimension of patient-centred endometriosis care, were significant when compared to the Bonferroni corrected p-value (all p ≥ 0.010). The EHP-30 domain ‘social support’ proved to be significantly associated to the following three dimensions of patient-centered endometriosis care (in order of strength): ‘information, communication and integration of care’ (p < 0.001, Beta=0.436), ‘coordination and integration of care’ (p = 0.001, Beta=0.307), and ‘emotional support and alleviation of fear and anxiety’ (p = 0.002, Beta=0.259). Limitations, reasons for caution This cross-sectional studies identified associations rather than proving causality between experiencing less patient-centeredness of care and having lower quality of life. Nevertheless, it is very tangible that some causality exists, either directly or indirectly (e.g. through empowerment) and that by improving patient-centeredness, quality of life might be improved as well. Wider implications of the findings Improving the patient-centeredness of endometriosis care was already considered an important goal, but even more so given its association with women’s quality of life, which is increasingly considered the ultimate measure of health care quality. Trial registration number not applicable

O-158 The evolution of the quality of life of women and men during the fertility clinic trajectory: a longitudinal survey

Abstract Study question How does the overall quality of life (QoL) of infertile women and men evolve during the diagnostic workup and during intrauterine insemination (IUI)? Summary answer The diagnostic workup affects the overall QoL of neither women nor men but both partner’s QoL is diminished by the time of their third IUI. What is known already Overall quality of life (QoL) is increasingly acknowledged as the ultimate measure of health care quality. The WHO defines ‘overall QoL’ as an individual’s perception of their position in life in relation to their context, goals, expectations, standards and concerns. Infertility threatens the life goal of becoming parents. Value preference studies concluded that cost analyses should consider a decrement in women’s QoL for ‘being infertile with the desire for a child’. The short-term QoL costs or benefits of the fertility clinic trajectory, before potentially achieving the long-term benefit of a live birth, have yet to be examined. Study design, size, duration Two cohorts consulting a Belgian fertility clinic were studied longitudinally. Cohort 1 (C1) included 36 women and their partners (response rate 54%), who were surveyed before their first consultation (T1) and three months later, towards the end of their diagnostic workup (T2; 2017-2019). Cohort 2 (C2) included 23 women and their partners (response rate 64%), who were surveyed during their diagnostic workup (T1) and at the time of their third IUI (T2; 2020-2021). Participants/materials, setting, methods Dutch- or English-speaking heterosexual couples first consulting a fertility clinic were eligible. Overall QoL was assessed with the valid and reliable linear analogue scale (LAS; range: 1-100; the higher, the better QoL; Moons et al., Eur J Cardiovasc Prev Rehabil, 2006). Paired samples t-tests assessed the evolution in the overall QoL of women and of men. Linear models examined whether already being parents and male factor infertility affected change scores. Main results and the role of chance Women and men of both cohorts were on average in their early thirties and couples had tried to conceive naturally for, on average, 19 (C1) and 16 (C2) months. Most individuals (65.4% in C1; 87% in C2) did not yet parent a child. A considerate proportion of couples had been diagnosed with (amongst others) male factor infertility (34.6% in C1; 26.0% in C2). The diagnostic workup did not affect the overall QoL of women (T1: 78.8±8.1 vs. T2: 75.8±9.7, p = 0.147) or men (T1: 80.8±7.9 vs. T2: 79.2±8.7, p = 0.206). The evolution in overall QoL throughout the diagnostic workup did not depend on parenthood status or male factor infertility (p > 0.05). By the time of their third IUI, women’s overall QoL had diminished (T1: 80.9±9.9 vs. T2: 74.0±15.0, p = 0.018). This evolution was not affected by parenthood status or male factor infertility (p > 0.05). Similarly, men’s overall QoL had diminished by the time of their third IUI (T1: 82.0±7.2 vs. T2: 78.1±9.6, p = 0.042). This reduction in men’s QoL was not affected by parenthood status (p = 0.759) but was especially observed (p = 0.028) among men without male factor infertility (T1: 82.9±7.9 vs. T2: 77.0±11.0, p = 0.008). Limitations, reasons for caution The rather small sample sizes were sufficient for examining the effect on QoL of time and two potential determinants (parenthood status, male factor infertility) according to the rule of thumb of including minimally five individuals per variable. Recruitment is still ongoing to increase the power of these cohort studies. Wider implications of the findings Fertility nurses/midwives should inform couples pursuing their life goal of parenthood that the fertility clinic trajectory will require short-term sacrifices. The diagnostic workup affects the overall QoL of neither women nor men, but both partner’s overall QoL is slightly diminished by the time of their third unsuccessful intrauterine insemination. Trial registration number not applicable

Evaluation of Telehealth Service for COVID-19 Outpatients: A Dashboard to Measure Healthcare Quality and Safety.

Due to the COVID-19 pandemic, changes and improvements regarding the organization have been made to adapt quickly at the Emergency Department (ED) of the Hospital Italiano de Buenos Aires, Argentina. This article describes the design, implementation, and use of an electronic dashboard which provided monitoring of patients discharged home, during follow-up with telehealth. It was useful to access essential information to organize and coordinate professional work and patients' surveillance, providing highly relevant data in real-time as proxy variables for quality and safety during home isolation. The implemented tool innovated in the integration of technologies within a real context. The information management was crucial to optimize services and decision-making, as well to guarantee safety for healthcare workers and patients.

A novel Health Disparities Index and acute asthma management

A novel Health Disparities Index and acute asthma management

Clinical Characteristics and Mortality of Old and Very Old Patients Hospitalized for Hip Fracture or Acute Medical Conditions

BackgroundThere is increasing interest in healthcare quality and economic implications for hip fracture patients of very old age. However, results are limited by access to comparable control groups.ObjectivesWe examined healthcare quality measures including mortality and length of stay (LOS) in hospital of adults aged 60–107 years undergoing hip operations, compared to an age-matched group admitted for acute general medical conditions.DesignMonocentric cross-sectional study.SettingAshford and St Peter’s Hospitals NHS Foundation Trust, Surrey, United Kingdom.ParticipantsA total of 3972 consecutive admissions for hip operation from 1st April 2009 to 30th June 2019 (dataset-1) and 6979 for acute general medical conditions from 1st April 2019 to 29th February 2020 (dataset-2). Respective ages, mean (±standard deviation), were 83.5 years (±9.1) and 79.8 years (±9.8).MeasurementsMortality and LOS were assessed with each group divided into five- year age bands and those ≥95 years.ResultsThere were proportionally more (P <0.001) females admitted for hip operations (72.8%) than for acute general medical conditions (53.8%). Amongst patients admitted with general medical conditions, the frequency of the most serious recorded conditions - including congestive heart failure, stroke, and pneumonia - increased with age. Amongst patients undergoing hip operations, 5.7% died in hospital and 29.3% had a LOS ≥3 weeks. Corresponding values for acute general medical conditions were 10.4% and 11.8%. For those undergoing hip operations in all age categories, the risk of death was lower than for acute general medical group: sex-adjusted odds ratios ranged between 0.27 and 0.67, but the risk of LOS ≥3 weeks was greater: odds ratios ranged between 2.46 and 2.95.ConclusionsCompared to those admitted with acute general medical conditions, patients admitted for hip operations had a lower risk of death, but a longer hospital LOS.

Development and validation of a quality indicator system for outpatient service in Shenzhen, China.

Outpatient services account for a large part of healthcare in China, and to survive in the competition with other hospitals, the management needs to understand and measure outpatient services quality for healthcare improvement and patient retention. There is a lack of comprehensive standardized outpatient healthcare quality measurement tools from patients' perspective in China. This study aimed to develop and test a quality indicator system for outpatient services assessment in the Chinese healthcare sector. Twenty-nine indicators were generated using literature review and focus group interviews. A modified Delphi process with the analytic hierarchy process was conducted to screen and determine the final indicators with 13 interdisciplinary panelists through two-round email surveys. A two-level and three-column questionnaire was distributed to 250 outpatients in Shenzhen to pretest the indicator system. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient and degree of concentration of opinions. The reliability of the questionnaire was assessed using Cronbach's alpha coefficient and inter-subscale correlation. Of the two rounds of Delphi consultation, the active coefficients were 76.92% and 80%, and the authoritative coefficients were both 0.88. An assessment system for the Chinese outpatient services quality was constructed with six first-level dimensions and 23 second-level indicators. The weights of safety, tangibility, reliability, responsiveness, assurance and empathy were 0.286, 0.096, 0.088, 0.135, 0.226 and 0.169, respectively. For the pretest, Cronbach's alpha values for the importance of the indicator, perception of quality of service and expected quality of service were 0.96, 0.94 and 0.96, respectively. The values of the Kaiser-Meyer-Olkin test were 0.94, 0.93 and 0.95. All Bartlett's test results showed that the correlation matrix was significant (P < 0.001). A multidimensional quality indicator system from patients' perspective was developed for the outpatient services assessment in China's healthcare sector. It has good validity and reliability and can be applied as a standardized tool by healthcare managers and policymakers in China to measure patients' perceptions and expectations.

Burden of treatment as a measure of healthcare quality: An innovative approach to addressing global inequities in multimorbidity.

Burden of treatment as a measure of healthcare quality: An innovative approach to addressing global inequities in multimorbidity.

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care.

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care.

Stakeholder Engagement: Bridging Research and Policy to Improve Measurement and Dental Care for Children in Medicaid.

Stakeholder Engagement: Bridging Research and Policy to Improve Measurement and Dental Care for Children in Medicaid.

PQMP Phase 2: Implementation and Dissemination.

In 2009, the Children's Health Insurance Program Reauthorization Act provided an opportunity to consider and enhance the measurement of children's health care quality as a means to improve child health.1 The legislation required the identification of an initial Child Core Set of pediatric quality measures for voluntary use by Medicaid/Child Health Insurance Programs. The initial child core set was published in 2009 and is updated annually with 2024 being the first year of mandatory reporting.2

Cigarette taxation and neonatal and infant mortality: A longitudinal analysis of 159 countries.

Previous studies on the associations between cigarette taxes and infant survival have all been in high-income countries and did not examine the relative benefits of different taxation levels and structures. We evaluated longitudinal associations of cigarette taxes with neonatal and infant mortality globally. We applied country-level panel regressions using 2008-2018 annual mortality and biennial WHO tobacco taxation data. Complete data was available for 159 countries. Outcomes were neonatal and infant mortality. We conducted analyses by type of taxes (i.e. specific cigarette taxes, ad valorem taxes, and other taxes, import duties and VAT) and the income group classification of countries. Covariates included scores for other WHO recommended tobacco control policies, socioeconomic, health-care, and air quality measures. Secondary analyses investigated the associations between cigarette tax and cigarette consumption. We found that a 10 percentage-point increase in total cigarette tax as a percentage of the retail price was associated with a 2.6% (95% Confidence Interval [CI]: 1.9% to 3.2%) decrease in neonatal mortality and a 1.9% (95% CI: 1.3% to 2.6%) decrease in infant mortality globally. Estimates were similar for both excise and ad valorem taxes. We estimated that 231,220 (95% CI: 152,658 to 307,655) infant deaths could have been averted in 2018 if all countries had total cigarette tax at least 75%. 99.2% of these averted deaths would have been in low- and middle-income countries (LMICs). The secondary analysis supported causal interpretation of results by finding that a 10 percentage-point increase in taxes was associated with a reduction of 94.6 (95% CI: 32.7 to 156.5) in annual cigarette consumption per capita. Although causal inference is precarious due to the quasi-experimental design, we used a robust analytical approach and focused on within-country changes. Limitations include an inability to include data on roll-your-own tobacco, other forms of tobacco use, and reliance on taxation data only for the cigarette brands most sold in each country. In line with limited existing evidence conducted in HICs, we found that raising taxes on tobacco was associated with a reduction in neonatal and infant mortality globally. Implementing recommended levels of taxation in LMICs should be a priority since this is where the lowest levels of taxation and the largest potential infant mortality benefits exist.

Do Proposed Quality Measures for Carpal Tunnel Release Reveal Important Quality Gaps and Are They Reliable?

Do Proposed Quality Measures for Carpal Tunnel Release Reveal Important Quality Gaps and Are They Reliable?

Construction of a Scale Assessing Patients' Perceptions Regarding Sanitation and Hygiene in a Clinical Setting.

This study attempted to develop a scale, hereby called HYGIENICCARE, that assesses patients' perceptions regarding sanitation and hygiene in a healthcare environment. It also evaluated the relationship between the new measure and a previously validated scale measuring healthcare quality. This study was a psychometric test in which we constructed a new survey and administered the survey to patients in wards and the outpatient departments of 5 hospitals in Accra North. A robust procedure, including a review of selected questions by an expert panel, was followed to determine the original bank of items of the instrument. Principal component analysis with varimax rotation was used to select items for the scale, whereas confirmatory factor analysis was used to assess construct validity. Multiple linear regression was used to examine the association between the new scale and an existing measure of healthcare quality. A bank of 10 items was determined through a systematic review of the literature and the engagement of 7 expert reviewers. Through principal component analysis, the items were reduced to 9. Principal component analysis yielded 2 factors: "environment and equipment" and "personnel and process," which both explained 82% of the total variance and produced Cronbach α coefficients of 0.912 and 0.86, respectively. Confirmatory factor analysis confirmed the 2-factor solution and produced satisfactory discriminant validity and convergent validity indicators. The 2 domains of the new scale were highly correlated with all dimensions of a scale measuring healthcare quality called HEALTHQUAL (r ≥ 0.76, P < 0.001). In multiple linear regression, each of the 2 domains of HYGIENICCARE explained a total variance of 41% or greater in all domains of HEALTHQUAL (P < 0.001). We developed a brief scale measuring hospital hygiene and sanitation that correlated well with an existing measure of healthcare quality. This effort shows that the new tool is a valid measure of patient-perceived hospital hygiene and sanitation.

Disease Severity and Risk Factors of 30-Day Hospital Readmission in Pediatric Hospitalizations for Pneumonia.

Pneumonia is the leading cause of hospitalization in pediatric patients. Disease severity greatly influences pneumonia progression and adverse health outcomes such as hospital readmission. Hospital readmissions have become a measure of healthcare quality to reduce excess expenditures. The aim of this study was to examine 30-day all-cause readmission rates and evaluate the association between pneumonia severity and readmission among pediatric pneumonia hospitalizations. Using 2018 Nationwide Readmissions Database (NRD), we conducted a cross-sectional study of pediatric hospitalizations for pneumonia. Pneumonia severity was defined by the presence of respiratory failure, sepsis, mechanical ventilation, dependence on long-term supplemental oxygen, and/or respiratory intubation. Outcomes of interest were 30-day all-cause readmission, length of stay, and cost. The rate of 30-day readmission for the total sample was 5.9%, 4.7% for non-severe pneumonia, and 8.7% for severe pneumonia (p < 0.01). Among those who were readmitted, hospitalizations for severe pneumonia had a longer length of stay (6.5 vs. 5.4 days, p < 0.01) and higher daily cost (USD 3246 vs. USD 2679, p < 0.01) than admissions for non-severe pneumonia. Factors associated with 30-day readmission were pneumonia severity, immunosuppressive conditions, length of stay, and hospital case volume. To reduce potentially preventable readmissions, clinical interventions to improve the disease course and hospital system interventions are necessary.

Impact of hospital mergers: a systematic review focusing on healthcare quality measures.

BackgroundDespite mergers have increasingly affected hospitals in the recent decades, literature on the impact of hospitals mergers on healthcare quality measures (HQM) is still lacking. Our research aimed to systematically review evidence regarding the impact of hospital mergers on HQM focusing especially on process indicators and clinical outcomes.MethodsThe search was carried out until January 2020 using the Population, Intervention, Comparison and Outcome model, querying electronic databases (MEDLINE, Scopus, Web Of Science) and refining the search with hand search. Studies that assessed HQM of hospitals that have undergone a merger were included. HQMs were analyzed through a narrative synthesis and a strength of the evidence analysis based on the quality of the studies and the consistency of the findings.ResultsThe 16 articles, included in the narrative synthesis, reported inconsistent findings and few statistically significant results. All indicators analyzed showed an insufficient strength of evidence to achieve conclusive results. However, a tendency in the decrease of the number of beds, hospital staff and inpatient admissions and an increase in both mortality and readmission rate for acute myocardial infarction and stroke emerged in our analysis.ConclusionsIn our study, there is no strong evidence of improvement or worsening of HQM in hospital mergers. Since a limited amount of studies currently exists, additional studies are needed. In the meanwhile, hospital managers involved in mergers should adopt a clear evaluation framework with indicators that help to periodically and systematically assess HQM ascertaining that mergers ensure and primarily do not reduce the quality of care.

Quality of care indicator performance was minimally changed in 2020 despite the COVID-19 pandemic

BackgroundIn 2020, the COVID-19 pandemic affected healthcare systems throughout the world, including the management of patients and compliance rates of quality indicators.ObjectiveTo measure the impact in Israel of the COVID-19 pandemic on the indicator-relevant caseload and compliance rates of the quality indicators reported by medical services providers within the Israeli National Program for Quality Indicators (NPQI).MethodsData was collected from the reports made to the NPQI by participating hospitals and medical service providers. The indicator results for the number of cases and compliance rates for 2019 were compared to those from 2020. We assessed and compared the results of the quality indicators in general hospitals, geriatric hospitals and departments, psychiatric hospitals and departments, emergency medical services (EMS), and Mother and Baby health centers.ResultsWe found a decrease in measurable cases in 2020 relative to 2019, especially in geriatric hospitals. In most indicators, compliance rates rose in 2020. Few indicators had lower compliance rates associated with COVID-19 pandemic regulations.Conclusions and policy implicationsRoutine medical activity decreased in Israel in 2020 in comparison to 2019, as reflected by a decrease in cases, but compliance rates were better in most indicators. The results of our study imply that the functioning of healthcare quality measurement programs should not be interrupted during a pandemic. This not only allows measuring of the healthcare system's performance during a crisis, but also may assist in maintaining a high level of healthcare quality.

An evidence-based, structured, expert approach to selecting essential indicators of primary care quality.

BackgroundThe purpose of this article is to illustrate the application of an evidence-based, structured performance measurement methodology to identify, prioritize, and (when appropriate) generate new measures of health care quality, using primary care as a case example. Primary health care is central to the health care system and health of the American public; thus, ensuring high quality is essential. Due to its complexity, ensuring high-quality primary care requires measurement frameworks that can assess the quality of the infrastructure, workforce configurations, and processes available. This paper describes the use of the Productivity Measurement and Enhancement System (ProMES) to compile a targeted set of such measures, prioritized according to their contribution and value to primary care.MethodsWe adapted ProMES to select and rank existing primary care measures according to value to the primary care clinic. Nine subject matter experts (SMEs) consisting of clinicians, hospital leaders and national policymakers participated in facilitated expert elicitation sessions to identify objectives of performance, corresponding measures, and priority rankings.ResultsThe SMEs identified three fundamental objectives: access, patient-health care team partnerships, and technical quality. The SMEs also selected sixteen performance indicators from the 44 pre-vetted, currently existing measures from three different data sources for primary care. One indicator, Team 2-Day Post Discharge Contact Ratio, was selected as an indicator of both team partnerships and technical quality. Indicators were prioritized according to value using the contingency functions developed by the SMEs.ConclusionOur article provides an actionable guide to applying ProMES, which can be adapted to the needs of various industries, including measure selection and modification from existing data sources, and proposing new measures. Future work should address both logistical considerations (e.g., data capture, common data/programming language) and lingering measurement challenges, such as operationalizating measures to be meaningful and interpretable across health care settings.

Relationships Between Pediatric Safety Indicators Across a National Sample of Pediatric Hospitals: Dispelling the Myth of the "Safest" Hospital.

There are many measures of healthcare quality, but no obvious summary measures to simplify ranking of hospital performance. With public reporting and accountability for hospital performance, the validity of composite measures for performance rankings has increased importance. This study aimed to explore the covariance of pediatric hospital quality indicators and evaluate the use of a single composite score. We performed an observational study of pediatric hospital performance across 13 safety indicators extracted from the Pediatric Health Information System, a comparative database of children's hospitals in the United States. We included patients discharged from 36 hospitals from January 1, 2016, to December 31, 2019. Using principal components analysis, we investigate relationships among patient safety measures from the Agency for Healthcare Research and Quality pediatric quality indicators and Center for Medicare and Medicaid Services hospital-acquired conditions. We compare and summarize rankings based on individual safety indicators and calculate alternative composite scores. We identified 5 orthogonal variance components accounting for 68% of variation in pediatric hospital quality indicators. Rankings demonstrated greater within-hospital variation compared with between-hospital variation. We observed discordant rankings across commonly used summary measures and conclude that these pediatric safety measures demonstrate at least 2 underlying variance components. This study demonstrates the multifactorial nature of patient safety. This implies no unique ordering of hospitals based on these measures, and thus, no pediatric hospital can claim to be "the safest." This raises further questions about appropriate methods to rank hospitals by safety.

Stability of healthcare quality measures for maternal and child services: Analysis of the continuous service provision assessment of health facilities in Senegal, 2012-2018.

ObjectiveHigh‐quality healthcare is essential to ensuring maternal and newborn survival. Efficient measurement requires knowing how long measures of quality provide consistent insight for intended uses.MethodsWe used a repeated health facility assessment in Senegal to calculate structural and process quality of antenatal care (ANC), delivery and child health services in facilities assessed 2 years apart. We tested agreement of quality measures within facilities and regions. We estimated how much input‐adjusted and process quality‐adjusted coverage measures changed for each service when calculated using quality measurements from the same facilities measured 2 years apart.ResultsOver 6 waves of continuous surveys, 628 paired assessments were completed. Changes at the facility level were substantial and often positive, but inconsistent. Structural quality measures were moderately correlated (0.40–0.69) within facilities over time, more so in hospitals; correlation was <0.20 for process measures based on direct observation of ANC and child visits. Most measures were more strongly correlated once averaged to regions; process quality of child services was not (−0.32). Median relative difference in national‐adjusted coverage estimates was 6.0%; differences in subnational estimates were largest for process quality of child services (19.6%).ConclusionContinuous measures of structural quality demonstrated consistency at regional levels and in higher level facilities over 2 years; results for process measures were mixed. Direct observation of child visits provided inconsistent measures over time. For other measures, linking population data with health facility assessments from up to 2 years prior is likely to introduce modest measurement error in adjusted coverage estimates.

Innovation in the pediatric electronic health record to realize a more effective platform

Commercial electronic health records (EHRs) were first developed to automate business processes. As EHRs developed, design principles focused on transferring existing paper-based documentation to comparable electronic forms. In addition, a strong industry focus on adult healthcare settings and quality measures has limited attention and resources for high priority EHR functionality needed for the unique health care of children. The objective of this paper is to provide a review of innovation in the EHR, that includes a variety of established and emerging technologies that may help realize a more effective EHR in child health settings. A more effective EHR would serve as an electronic hub. Existing EHR infrastructure could provide the foundation upon which new technologies and approaches branch and extend, enabling more rapid and customizable innovation to better meet shifting stakeholder and end-user needs. Among many areas for improvement, key goals of innovation could include technology that relieves ambulatory primary care clinician documentation burden, identifies needs, and supports improved care coordination and outcomes, focused on the following key areas: identification of child and family care needs, decision support, documentation, care coordination, and family communication.