Quality of health care in the United States: implications for pediatric inflammatory bowel disease

Abstract

The Institute of Medicine's publications To Error is Human and Crossing the Quality Chasm publicized the widespread deficits in US health care quality. Emerging studies continue to reveal deficits in the quality of adult and pediatric care, including subspecialty care. In recent years, key stakeholders in the health care system including providers, purchasers, and the public have been applying various quality improvement methods to address these concerns. Lessons learned from these efforts in other pediatric conditions, including asthma, cystic fibrosis, neonatal intensive care, and liver transplantation may be applicable to the care of children with inflammatory bowel disease (IBD).This review is intended to be a primer on the quality of care movement in the United States, with a focus on pediatric IBD. In this article, we review the history, rationale, and methods of quality measurement and improvement, and we discuss the unique challenges in adapting these general strategies to pediatric IBD care.

Figure 1. The chronic care model

The chronic care model, a useful framework for delivery system design, posits that improved patient outcomes are the result of carefully designed and coordinated systems of care that include patient and family self-management support, delivery system design, decision support, and clinical information systems working in concert with the greater health care organization and community resources.

Figure 2. The Model for Improvement

The Model for Improvement describes a stepwise process for process improvement. Time-sensitive and measurable aims are established, quantitative measures are developed to determine whether specific changes lead to improvement, and changes that are most likely to result in improvement are identified. Changes are then tested on a small scale using the Plan-Do-Study-Act (PDSA) cycle-planning interventions, trying them, observing the results, and acting on what is learned.