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IOM Calls for National Quality Measures for Pediatric Healthcare

 |  By cclark@healthleadersmedia.com  
   April 27, 2011

As surprising as it may seem, the U.S. lacks a unified system to measure quality of care and health status for children and adolescents, says a report entitled "Measuring What Matters" issued by the Institute of Medicine and National Research Council.

While numerous independent federal and state databases exist for this purpose, "the fragmentation of existing data sources impedes access to and timely use of the information they collectively provide," the groups said.

"The U.S. currently has no robust national information system that can provide timely, comprehensive, and valid and reliable indicators of health and healthcare quality for children and adolescents."

The report is the result of an 18-month investigation ordered by the U.S. Health and Human Services Agency in 2009 "to identify key advances in the development of pediatric health and healthcare quality measures, examine the capacity of existing federal data sets to support these measures, and consider related research activities focused on development of new measures to address current gaps."

The 266-page document makes 10 recommendations to improve the system for children and teens. They are:

1. The HHS Secretary should convene an interagency group to set quality goals within a life-course framework.

2. Annual reports to Congress should include specific pediatric measures of quality of care and should include standard definitions of race/ethnicity, socioeconomic status, and special healthcare needs. The goal is to identify and eliminate disparities. Information on primary language and parental English proficiency should be included.

3. The data system should entail creating a strategy for continuously improving the system, and identifying obsolete, unnecessary, or redundant measures as well as highlighting emerging candidates for new ones.

4. New measures should include preventive services with an emphasis on the child's life-course, and include metrics in oral, mental and behavioral health as well as substance abuse. Such emphasis "can pay dividends in savings to the healthcare system by addressing problems before they appear later in life."

5. Measures should focus on relationships between the social determinants of pediatric health and should support interagency collaboration with HHS.

6. The measures should include health conditions, levels of functioning, and access to care.

7. The Secretary should place priority on interactions between HHS agencies and other federal agencies to strengthen the capacity to link data sources in behavioral health and social determinants.

8. The effort should set a goal of improving timeliness and fostering greater transparency in healthcare, educational and social services.

9. The linking of data and research should resolve legal and ethical concerns about privacy and data sharing.

10. HHS should establish a timetable for all states to report on a core set of standardized measures that can be used in the health information technology infrastructure to assess health and healthcare quality.

The report's conclusions emphasize that existing data sources have strengths and limitations, but lack common definitions and common data elements, such as insurance coverage status.

It specifies the need to get a better understanding of a child's health literacy, biological influences, health status of family members, health issues in geographic regions or neighborhoods, and other ways to look at the whole child.

The report also points to the need for a long-term view, and the importance of obtaining longitudinal data on the same families and same children over time.

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