Challenge to Child Health Services Research: Report From the Committee on Pediatric Health and Health Care Quality Measures

2011 ◽  
Vol 11 (4) ◽  
pp. 257-259 ◽  
Author(s):  
Marie C. McCormick ◽  
Glenn Flores ◽  
Gary L. Freed ◽  
Charles J. Homer ◽  
Kevin B. Johnson ◽  
...  
Keyword(s):  
Health Care ◽  
Child Health ◽  
Health Services Research ◽  
Health Services ◽  
Health Care Quality ◽  
Quality Measures ◽  
Care Quality ◽  
Child Health Services ◽  
Research Report ◽  
Services Research

How Do We Align Health Services Research and Quality Improvement?

2020 ◽  
pp. 282-291
Author(s):  
Devika Das ◽  
Lalan Wilfong ◽  
Katherine Enright ◽  
Gabrielle Rocque
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Services Research ◽  
Health Services ◽  
Health Care Quality ◽  
Care Delivery ◽  
Care Quality ◽  
Health Care Use ◽  
Semistructured Interview ◽  
Services Research

Quality improvement (QI) initiatives and health services research (HSR) are commonly used to target health care quality. These disciplines are increasingly important because of the movement toward value-based health care as alternative payment and care delivery models drive institutions and investigators to focus on reducing unnecessary health care use and improving care coordination. QI efforts frequently target medical error and/or efficiency of care through the Plan-Do-Study-Act methodology. Within the QI framework, strategies for data display (e.g., Pareto charts, run charts, histograms, scatter plots) are leveraged to identify opportunities for intervention and improvement. HSR is a multidisciplinary field of study that seeks to identify the most effective way to organize, deliver, and finance health care to maximize the quality and value of care at both the individual and population levels. HSR uses a diverse set of quantitative and qualitative methodologies, such as case-control studies, cohort studies, randomized control trials, and semistructured interview/focus group evaluations. This manuscript provides examples of methodologic approaches for QI and HSR, discusses potential challenges associated with concurrent quality efforts, and identifies strategies to successfully leverage the strengths of each discipline in care delivery.

Musculoskeletal healthcare at a Swiss university hospital chiropractic medicine outpatient clinic in 2019: a health services research study

2021 ◽  
Author(s):  
Léonie Hofstetter ◽  
Melanie Häusler ◽  
Malin Mühlemann ◽  
Luana Nyirö ◽  
Daniel Mühlemann ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Assurance ◽  
Health Services Research ◽  
Health Services ◽  
Health Care Quality ◽  
Research Study ◽  
Clinical Care ◽  
Care Quality ◽  
University Hospital ◽  
Services Research

Abstract Background The Balgrist University Hospital in Zurich, Switzerland, is an academic hospital focused on musculoskeletal (MSK) disorders. An integrated chiropractic medicine clinic provides chiropractic care to a broad patient population. Our health services research study aims to advance understanding of chiropractic health care service for quality assurance and health care quality improvement. Methods An observational clinical cohort study at the Balgrist chiropractic medicine clinic in 2019 was performed. The records of all patients with initial visits or returning initial visits (> 3 months since last visit) and their subsequent visits from January 1, 2019 to December 31, 2019, were used to create the study dataset. Data collected included demographic characteristics, diagnoses, imaging data, conservative treatments, surgeries, and other clinical care data. Descriptive statistics were used to summarize data. Results 1844 distinct patients (52% female, mean age 48 ± 17 years) were eligible and included in the study. 1742 patients had a single initial visit, 101 had 2 initial visits, and 1 patient had 3 initial visits during the study period. The most common main diagnoses were: low back pain (41%; 95% CI, 39–43%), neck pain (21%; 19–23%), and thoracic pain (8%; 7–9%). 29% had an acute (< 4 weeks) symptom duration, 10% subacute (4 to 12 weeks), and 52% chronic (> 12 weeks). Patients had a median number of 5 chiropractic visits during their episode of care, with a median care episode duration of 28 days. Only 49% (95% CI, 47–52%) of patient records had a clinical outcome that was extractable from routine clinical practice documentation retrievable from the hospital system. Conclusion Our health services research study provides an initial understanding of the patient characteristics and MSK clinical care delivered in a Swiss outpatient hospital setting and areas for clinical data quality assurance. Deeper insights into health care services and outcomes will help to facilitate a health quality improvement initiative by identifying clinical data and health care quality gaps, and establishing overall aims and targets for improvement.

Child Health Services Research

JAMA ◽  
1997 ◽  
Vol 277 (22) ◽  
pp. 1787 ◽  
Author(s):  
Christopher B. Forrest
Keyword(s):  
Child Health ◽  
Health Services Research ◽  
Health Services ◽  
Child Health Services ◽  
Services Research

Road to the Future: Priorities for Child Health Services Research

2017 ◽  
Vol 17 (8) ◽  
pp. 814-824 ◽  
Author(s):  
Gerry Fairbrother ◽  
Denise Dougherty ◽  
Rosina Pradhananga ◽  
Lisa A. Simpson
Keyword(s):  
Child Health ◽  
Health Services Research ◽  
Health Services ◽  
Child Health Services ◽  
Services Research ◽  
The Future

Quality Measures for Children’s Health Care

PEDIATRICS ◽  
2004 ◽  
Vol 113 (Supplement_1) ◽  
pp. 199-209 ◽  
Author(s):  
Anne C. Beal ◽  
John Patrick T. Co ◽  
Denise Dougherty ◽  
Tanisha Jorsling ◽  
Jeanelle Kam ◽  
...  
Keyword(s):  
Health Care ◽  
Child Health ◽  
End Of Life ◽  
Health Care Quality ◽  
Quality Measures ◽  
Care Quality ◽  
Children's Health ◽  
Children’S Health ◽  
Care Needs ◽  
Children’S Health Care

Background. The ability to measure and improve the quality of children’s health care is of national importance. Despite the existence of numerous health care quality measures, the collective ability of measures to assess children’s health care quality is unclear. A review of existing health care quality measures for children is timely for both assessing the current state of quality measures for children and identifying areas requiring additional research and development. Objectives. To identify and collect current health care quality measures for child health and then to systematically categorize and classify measures and identify gaps in child health care quality measures requiring additional development. Design/Methods. We first identified child health care quality instruments with assistance from staff at the Agency for Healthcare Research and Quality, experts in the field, the Computerized Needs-oriented Quality Measurement Evaluation System, the Child and Adolescent Health Measurement Initiative, and a medical literature review. From these instruments, we then selected clinical performance measures applicable to children (aged 0–18 years). We categorized the individual measures into the Institute of Medicine’s framework for the National Health Care Quality Report. The framework includes health care quality domains (patient safety, effectiveness, patient-centeredness, and timeliness) and patient-perspective domains (staying healthy, getting better, living with illness, and end-of-life care). We then determined the balance of the measures (how well they assess care for all children versus children with special health care needs) and their comprehensiveness (how well the measures apply to the developmental range of children). Finally, we analyzed the ability of the measures to assess equity in care. Results. We identified 19 measure sets, and 396 individual measures were used to assess children’s health care quality. The distribution of measures in the health care quality domains was: safety, 14.4%; effectiveness, 59.1%; patient-centeredness, 32.1%; and timeliness, 33.3%. The distribution of measures in the patient-perspective domains was: staying healthy, 24%; getting better, 40.2%; living with illness, 17.4%; end of life, 0%; and multidimensional, 23.5% (measures were multidimensional if they applied to &gt;1 domain). Most of the measures were meant for use in the general pediatric population (81.1%), with a significant proportion designed for children with special health care needs (18.9%). The majority (≥79%) of the measures could be applied to children across all age groups. However, there were relatively few measures designed specifically for each developmental stage. Regarding the use of measures to study equity in health care, 6 of the measure sets have been used in previous studies of equity. All the survey measure sets contain items that identify patients at risk for poor outcomes, and 4 are available in languages other than English. However, only 1 survey (Consumer Assessment of Health Plans) has undergone studies of cross-cultural validation. Among the measure sets based on administrative data, 3 included infant mortality, a well-known measure of health disparity. Conclusions. There are several instruments designed to measure health care quality for children. Despite this, we found relatively few measures for assessing patient safety and living with illness and none for end-of-life care. Few measures are designed for specific age categories among children. Although equity is an overarching concern in health care quality, the application of current measures to assess disparities has been limited. These areas need additional research and development for a more complete assessment of health care quality for children.

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