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State and National Initiatives to Improve the Quality of Health Care for Children. Wanda D. Barfield, MD, MPH 13 th Annual Maternal Child Health Epidemiology Conference December 12, 2007. What is Healthcare Quality?.

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State and National Initiatives to Improve the Quality of Health Care for Children

Wanda D. Barfield, MD, MPH

13th Annual Maternal Child Health Epidemiology Conference

December 12, 2007

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What is Healthcare Quality? Health Care for Children

  • “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (IOM)

  • “Doing the right thing, at the right time, for the right person, and having the best possible result ” (AHRQ)

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Elements of Quality Healthcare Health Care for Children

  • Safe. Helps and does not cause harm.

  • Effective. Research shows positive (good) results.

  • Patient-centered. Healthcare providers treat patients with respect, accounting for patient's (family's) values about health and quality of life.

  • Timely. Getting needed at a time when it will do the most good.

  • Efficient. Treatment/Intervention does not waste money or time.

  • Equitable. Everyone is entitled to high quality healthcare.

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“Dennis Quaid's newborns reportedly Health Care for Children

harmed by medical


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To err is human…. Health Care for Children

To err systematically is inhumane….

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Targeting Quality Health Care Health Care for Children







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Is Quality Healthcare for Children Different than Adults? Health Care for Children

U.S. children

Have overall good physical health, but are experiencing increasing chronic illness

Experience disproportionate rates of poverty and limited health service resources

Depend on caregivers

Major focus on preventive health, and developmental surveillance

Immunizations, Newborn screening, Anticipatory guidance

Yes, but……

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The Quality of Children’s Health Care is No Better than Adults (and May Be Worse)

% Receiving Recommended Care

Source: McGlynn et al, NEJM 2003; 348:2635-45, and Mangione-Smith, et al, NEJM, 2007; 357:1515-23.

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Disparities: Adults (and May Be Worse)An Abyss within the Quality Chasm

Source: Smith et al. Pediatrics 2006:117;1763-70

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What is Needed to Change Quality (and Outcomes) of Care for Children?

  • Leadership (Board, Executive, Professional)

  • Engagement of patients, families, and community

  • Technical Expertise (Improvement Science)

  • Data and Tools (Health Information Technology)

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Why is this important to you? Children?

Children’s Health Care is:

Mostly preventative

Predominantly outpatient

Locally delivered and organized

State regulated

Substantially funded through state programs

Incorporated in state’s public health role (e.g., immunizations, newborn screening)

Part of state-federal programs (Medicaid, SCHIP)

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Session Objectives Children?

  • Overview quality within the levels of the healthcare system

  • Learn about strategies needed to promote, enable, and sustain improved quality of care

  • Demonstrate the usefulness of collaborating organizations in quality improvement

  • Understand the use of data to measure quality improvement

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Plenary Speakers Children?

  • Judith Shaw, EdD, MPH, RN

    • Executive Director, Vermont Child Health Improvement Program (VCHIP)

    • Associate Professor of Pediatrics, University of Vermont College of Medicine

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Plenary Speakers Children?

  • Doris Hanna, RN, CPNP, ScD

    • Director, National Initiative for Children’s Healthcare Quality (NICHQ), Pediatric Affinity Group

    • Project Executive, Childhood Obesity Action Network

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Plenary Speakers Children?

  • Christina Bethell, PhD, MPH, MBA

    • Associate Professor, Oregon Health and Science University

    • Founding Director, Child and Adolesecent Health Measurement Initiative (CAHMI)