It has been become commonplace in the last few years for health plans to determine the quality of care provided by their physicians by evaluating the contents of electronic claims data records. Physician-ordered services contained in the records are compared with those recommended in established guidelines of care for particular ailments, and physicians are informed of their compliance with these guidelines in an effort to improve treatment practices. This approach has proved itself very successful in the adult health arena, with a variety of organizations constructing sets of 'indicators' or 'measures' to rate care quality. Each measure is essentially a set of standards that apply a specific ailment, and can be implemented in software to evaluate the total number of case of the ailment and its compliance rate. But such an approach has not yet gained widespread use in the pediatric community. This is largely due to the lack of available measure sets specific to the conditions of children and adolescents. To help rectify this situation a set of forty to fifty measures will be developed covering a wide variety of pediatric conditions. An expert panel of pediatric generalists and specialists will be consulted in conjunction with established treatment guidelines to ensure correct and effective measure development. This set will be thoroughly tested on actual claims data to ensure optimal measure performance. The panel will be informed of the results of the testing and the process will be iterated until the set is honed to a level sufficient to provide accurate evaluation of pediatric care quality when using real claims data. Various methods of reporting the results of measure compliance to physicians will next be developed in consultation with industry leaders in health care. Once this is completed the measure set along with the software required to properly operate it will be marketed under software license.
This project is relevant to the current public need for improvement in pediatric health care. It is furthermore relevant to the National Institutes of Health's call for closing the gap between research and practice.
