Automating Quality and Safety Benchmarking for Children: Meeting the Needs of Health Systems and Patients
Our aim is to implement and test electronic measures of outpatient pediatric healthcare quality and safety using the Common Data Model (CDM) Version 3. We will test the creation of a benchmarking report so health systems can compare their performance to others. Without this information, hospitals do not know if they have the best quality care or the worst, and cannot learn from each other, which limits improvement. In our interviews, health system leaders expressed a critical need for electronic quality measures for benchmarking. We will focus on three well-established measures of quality: transcranial Doppler (TCD) screening for children with sickle cell disease; appropriate antibiotics for ear infections; and cholesterol and glucose testing for children on antipsychotic medications. Approximately 100,000 Americans have sickle cell disease; only 30 percent of children receive TCD screening, which identifies high risk for stroke and initiates treatments that reduce risk by 92 percent. Over 600,000 children take antipsychotic medications that greatly increase the risk for diabetes and high cholesterol; only 19 percent of these receive glucose and cholesterol tests. Only 70 percent of children with ear infections receive the appropriate antibiotics. We aim to:
- Using the PCORnet CDM, implement and evaluate electronic measures of pediatric safety and quality for three high-priority conditions.
- Determine the value of electronic measurement benchmarking to health system leaders.
Study design. We will achieve these aims in a study of two CDRNs, PEDSnet and OneFlorida, which together have 7.9 million children. We will implement the three measures using the CDM and then evaluate the reliability of these electronic measures against manual medical record review. We will also evaluate the ability of the CDM to correctly identify diagnoses, medications, and radiographic and laboratory testing. We will interview health system leaders to understand who will use this data and how to make it as useful as possible. This research will immediately impact care by learning how to develop high-value benchmarking systems and sharing benchmarking data with health systems. Because pediatric health systems have a long history of collaboration on quality and safety, we are uniquely well positioned to serve as a model for successful collaboration between PCORNet and networks of health systems.
Engagement. The study design and research questions were selected through a collaborative approach of parents, health system leaders, clinicians, and researchers. We will work with a health system advisory panel and a parent advisory panel. Both panels will review the study protocol, interim results, and provide key guidance for developing the framework for the dissemination plan and final report. Our advisors will inform dissemination, as they are part of three national pediatric learning networks of health system leaders, clinicians, and families that will help disseminate our findings.