"While pediatricians have been forceful advocates for better insurance coverage for children, they've been less active in the policy debate over quality of care. Their voices need be stronger at both the state and national levels," said Dr. Simpson, a USF professor of pediatrics and chief of the Division of Child Health Outcomes. "At the same time, parents need to be given clearly understandable information about quality indicators so they can make informed choices about health plans and medical care for their children on the basis of quality and cost."
Dr. Simpson is the co-author of a report titled "Measuring the Quality of Children's Healthcare: A Prerequisite to Action" published this month as a supplement to the journal Pediatrics. The paper's other author is Denise Dougherty, PhD, senior child health advisor at the Agency for Healthcare Research and Quality, the lead federal agency for research on the quality and safety of health care.
The article prioritizes recommendations to move forward the national agenda for improving the quality of children's health care. The recommendations were developed by a group of 40 child health experts, advocates and purchasers of health care who met in Washington, DC. The top recommendation was to create an information technology system, designed with children's unique needs in mind, that would help physicians and other practitioners more efficiently track health care indicators like patient satisfaction, emergency room visits, pain levels and treatment outcomes.
"Systems that work for children's health care and quality would not necessarily be a natural byproduct of mainstream information technology systems," the authors write. "For example, current computerized physician order-entry systems typically are not designed to include weight- and body-mass measurements, an essential part of preventing medication errors in children's health care."
The authors report that investing in the research and information technology needed to evaluate and improve children's health often takes a back seat to reducing the rising costs of health care – an issue re-emerging as a political hot button. Yet the two are inextricably linked, Dr. Simpson said. "Poor quality health care in childhood can lead to greater consumption of health services and lost productivity in adulthood. For example, failure to prevent, diagnose and treat obesity in childhood could set a person up for a higher lifetime risk of cardiovascular disease and other chronic illnesses."
Even when convincing evidence demonstrates that a medical practice results in better outcomes, practitioners often fall short of providing optimal care for children, Dr. Simpson said. For example, despite clear evidence and guidelines for primary care of childhood asthma, less than 60 percent of pediatric patients receive the inhaled steroidal medications most effective in controlling the disease, she said. "Yet, experts agree that most emergency room visits and hospitalizations for asthma attacks could be avoided if more children were taking the right medications."
Dr. Simpson said pediatricians are critical to closing the gap between what is known about children's health (evidence-based practice) and what is often practiced. They can commit to improvement in their own practices and join in national research collaboratives such as the Pediatric Research in Office Settings (PROS) network sponsored by the American Academy of Pediatrics, she said. Pediatricians enrolled in PROS work with AAP researchers to design studies, obtain research funding, and collect and report shared findings.
"Across Florida, only 30 practices participate in PROS," Dr. Simpson said. "This is a great start, but we need even more good research by pediatricians at the practice level to provide the basis for new quality measures and to build public support for quality-improvement efforts."
* Dr. Simpson earned her medical degree in Ireland hence the different abbreviations. She received her pediatric training in the United States and is a licensed physician
Journal
PEDIATRICS