EDITORIAL

Bridging a chasm of quality in child health, too

There is little doubt that American medicine leads the world in research and technology, as well as in developing innovative therapies with the potential to enhance health and reduce the prevalence and severity of illness, injury, and disability. But there is substantial evidence that this potential isn't always realized.

A report released last month by the Committee on Quality of Health Care in America, created in 1998 by the Institute of Medicine, addresses systemic problems that frustrate efforts to implement quality health care. In "Crossing the Quality Chasm: A New Health System for the 21st Century,"* the committee describes those systemic problems as:

• inadequate systems for sharing health information among providers

• delay in consistent implementation of medical practices that are based on sound evidence

• reimbursement policies that are not aligned with practices known to maintain health and improve outcomes

• training that does not prepare medical providers to deliver evidence-based care in a world of expanding knowledge and rapid change.

The committee's report is directed to health-care organizations, professional societies, private and public purchasers of health care, and federal and state agencies. It offers 13 recommendations for making health care in the United States safe, effective, patient-centered, timely, efficient, and equitable. The report specifies methods by which recognized standards for quality care can be met.

Many of the committee's recommendations can be applied equally to the systems of health care for children and adults (there certainly is room for systematic improvement in the care provided to pediatric patients). Examples cited in the report, however, focus primarily on medical conditions and practices that pertain to adults. The importance of improving the quality of child health care will be easily lost in a national discussion of priorities that will surely follow release of this report.

Pediatricians have been superb advocates for the implementation of public health programs and public policies that affect children. But we have not worked consistently to build systems for improving the quality of care in offices, hospitals, and clinics. Like the rest of medicine, we tend to do the best we can in our setting and assume that others are doing the same in theirs.

The committee estimates that stimulating efforts to bring about rapid, significant change in the US health-care system will cost $1 billion over the next three to five years. As resources are allocated to address that "quality chasm," pediatricians and others concerned about the health of children must confront current inadequacies and join the effort to make systematic change.

Julia A. McMillan, MD, Editor-in-Chief of Contemporary Pediatrics, is Professor of Pediatrics, Vice Chair for Pediatric Education, and Director of the Residency Training Program, Johns Hopkins University Medical School, Baltimore

* Available for purchase at www.nap.edu/catalog/10027.html

 

Julia McMillan. Editorial: Bridging a chasm of quality in child health, too. Contemporary Pediatrics 2001;5:9.