Development of process and outcome measures for improvement: Lessons learned in a quality improvement collaborative for pediatric inflammatory bowel disease

Abstract

The Institute of Medicine's publications, To Err is Human and Crossing the Quality Chasm, publicized the widespread deficits in healthcare quality. The quality of care in inflammatory bowel disease (IBD) has not been comprehensively evaluated, in part due to a lack of well-established IBD measures of quality. Quality can be measured for evaluation, benchmarking, or continuous quality improvement, using structural, process, and outcome measures. Measurement is an essential component of the model for improvement, necessary to determine whether changes made have resulted in improvement. Measures used for quality improvement should be based on evidence and consensus, be clear and collectable in a timely fashion, occur with sufficient frequency, and have the potential to improve outcomes. While no current IBD measures of quality are perfect, an iterative process of measure development can produce a set of measures that are feasible, relevant, and useful for performing quality improvement. This review describes the history, rationale, and methods of quality measurement and discusses the early work and lessons learned from measuring quality of care in a pediatric IBD quality improvement collaborative.

Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis

“…22 For example, improvements in care processes as well as an increase in the proportion of patients whose disease was in remission at follow-up were reported with a pediatric inflammatory bowel disease network. 23,24 Although clinical networks may differ with respect to structure, governance and accountability mechanisms, our findings are in agreement with reports showing that such networks are associated with improved care delivery and outcomes. Our finding that patients of low socioeconomic status are most at risk for diabetes-related emergency department visits and hospital admissions within a universal-access health care system supports previous Ontario research.…”

Maintenance of Certification and the Challenge of Professionalism

“…ImproveCareNow was the prototype learning collaborative for MOC created by the ABP. 34 Similarly, Miller et al 29 described a 56% reduction in central lineassociated blood stream infections (CLABSI) among pediatric intensive care patients. A summary paper on exemplar learning collaboratives highlights that participating pediatric intensivists received MOC credit for reducing CLABSI rates through the Children's Hospital Association Quality Transformation Network.…”

Society for Pediatric Research Presidential Address 2011: improving child health outcomes—from 65 roses to high reliability

“…For example, by redesigning the delivery system and providing point-of -clinical-care decision support systems, this collaborative increased the number of encounters where all components of the inflammatory bowel disease classification bundle were completed from 22% at baseline in 2007 to 85% by 2009. Using this and a number of other improvements to the system, including feedback to teams, self-management support, and pre-visit planning, the remission rate for this population improved from approximately 45% at the beginning of the collaborative intervention to almost 75% (13,14).…”