Quality Measures in Pediatric Hospital Medicine: Moneyball or Looking for Fabio?

[摘要] “What are we doing here?” Brad Pitt asks a table full of weathered scouts in a memorable scene in the movie Moneyball. Playing Oakland Athletics manager Billy Beane, he goes on to critique the scouts' traditional, subjective ranking of players as “looking for Fabio.” The film is based on a book of the same name that chronicles the record-breaking success of the 2002 Oakland Athletics baseball team. At the heart of this achievement was the application of novel evidence-based metrics to maximize performance in the setting of a limited supply of fiscal resources.Optimizing value has evolved into a larger movement in sports, and quality measurement in medicine would be envious of a similar trajectory. Although reporting and regulatory requirements in medicine have increased in recent years, our metrics remain crude, often with an inability to attribute value to distinct players. Within pediatrics, hospital-based measures comprise <5% of the total available measures, despite the fact that inpatient care accounts for 40% of pediatric health care spending.1 Of the specific pediatric measures endorsed by the National Quality Forum for use in the inpatient setting (Table 1),2–5 few have relevance to the bulk of daily care provided by pediatric hospitalists.View this table:TABLE 1 National Quality Forum-Endorsed Inpatient Pediatric MeasuresThe measures that are the most relevant to pediatric hospital medicine (PHM), the Joint Commission's Children's Asthma Care (CAC) core measures for inpatient asthma, have recently been called into question in light of a large study that revealed no immediate link between components of the measures and readmis-sion rates for asthma.6 Although many hospitals, overtime, increased compliance with the home management plan of care requirement, readmission rates did not budge. Thus, there was systems-level process improvement but no change in outcome. Meanwhile, compliance rates for reliever and systemic corticosteroid use …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob