Emergency Department Quality: An Analysis of Existing Pediatric Measures

Authors

  • Evaline Alessandrini MD, MSCE,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center (EA, KV), Cincinnati, OH; the Department of Pediatrics, University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center, (EA, RMR), Cincinnati, OH; Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA, KS), Philadelphia, PA; the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI; the Department of Pediatrics, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC.
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  • Kartik Varadarajan MPH,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center (EA, KV), Cincinnati, OH; the Department of Pediatrics, University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center, (EA, RMR), Cincinnati, OH; Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA, KS), Philadelphia, PA; the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI; the Department of Pediatrics, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC.
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  • Elizabeth R. Alpern MD, MSCE,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center (EA, KV), Cincinnati, OH; the Department of Pediatrics, University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center, (EA, RMR), Cincinnati, OH; Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA, KS), Philadelphia, PA; the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI; the Department of Pediatrics, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC.
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  • Marc H. Gorelick MD, MSCE,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center (EA, KV), Cincinnati, OH; the Department of Pediatrics, University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center, (EA, RMR), Cincinnati, OH; Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA, KS), Philadelphia, PA; the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI; the Department of Pediatrics, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC.
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  • Kathy Shaw MD, MSCE,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center (EA, KV), Cincinnati, OH; the Department of Pediatrics, University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center, (EA, RMR), Cincinnati, OH; Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA, KS), Philadelphia, PA; the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI; the Department of Pediatrics, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC.
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  • Richard M. Ruddy MD,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center (EA, KV), Cincinnati, OH; the Department of Pediatrics, University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center, (EA, RMR), Cincinnati, OH; Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA, KS), Philadelphia, PA; the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI; the Department of Pediatrics, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC.
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  • James M. Chamberlain MD,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center (EA, KV), Cincinnati, OH; the Department of Pediatrics, University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center, (EA, RMR), Cincinnati, OH; Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA, KS), Philadelphia, PA; the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI; the Department of Pediatrics, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC.
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  • for the Pediatric Emergency Care Applied Research Network


  • Participating centers and site investigators for the Pediatric Emergency Care Applied Research Network are listed in Appendix A.

  • Funding obtained through a HRSA Emergency Medical Services for Children Targeted Issues Grant (Grant H34MC16597) and The Pediatric Emergency Care Applied Research Network (PECARN) is supported by cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008 from the Emergency Medical Services for Children (EMSC) program of the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services.

  • The authors have no relevant financial information or potential conflicts of interest to disclose.

  • Supervising Editor: Gregory P. Conners, MD, MPH, MBA.

Address for correspondence and reprints: Evaline A. Alessandrini, MD, MSCE; e-mail: evaline.alessandrini@cchmc.org.

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:519–526 © 2011 by the Society for Academic Emergency Medicine

Abstract

Objectives:  The Institute of Medicine (IOM) has recommended the development of national standards for the measurement of emergency care performance. The authors undertook this study with the goals of enumerating and categorizing existing performance measures relevant to pediatric emergency care.

Methods:  Potential performance measures were identified through a survey of 1) the peer-reviewed literature, 2) websites of organizations and societies pertaining to quality improvement, and 3) emergency department (ED) directors. Performance measures were enumerated and categorized, using consensus methods, on three dimensions: 1) the IOM quality domains; 2) Donabedian’s structure/process/outcome framework; and 3) general, cross-cutting, or disease-specific measures.

Results:  A total of 405 performance measures were found for potential use for pediatric emergency care. When categorized by IOM domain, nearly half of the measures were related to effectiveness, while only 6% of measures addressed patient-centeredness. In the Donabedian dimension, 67% of measures were categorized as process measures, with 29% outcome and 4% structure measures. Finally, 31% of measures were general measures relevant to every ED visit. Although 225 measures (55%) were disease-specific, the majority (56%) of these measures related to only five common conditions.

Conclusions:  A wide range of performance measures relevant to pediatric emergency care are available. However, measures lack a systematic and comprehensive approach to evaluate the quality of care provided.

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