Improving the Quality of Pediatric Emergency Care Using an Electronic Medical Record

Approximately 20% of all children in the US will have at least one Emergency Department (ED) visit each year, Patients and caregivers expect clinicians to deliver high quality emergency care, yet many children do not receive appropriate care under the current system. The Institute of Medicine report, "Emergency Care for Children: Growing Pains," notes that the delivery of care should be built on a strong foundation in which emergency care is based on scientific evidence, data are collected so clinicians can learn from past experience, and system performance is monitored to ensure quality. While EDs routinely collect substantial patient data with the potential to provide information on the quality of care provided, the capacity to capture, analyze and report these data back to front-line clinicians capable of acting to improve health care delivery has been limited. Leveraging advances in health information technology to access patient-centric clinical data, researchers can measure and identify variation in performance and outcomes, enhancing the ability to design and implement interventions to improve outcomes and quality of care across multiple settings. The increasing use of the electronic health record (HER) in EDs provides a unique opportunity. Utilizing the infrastructure of the Pediatric Emergency Care Applied Research Network (PECARN), this proposal will innovatively capture her data to implement and report performance measures with the ultimate goal of improving the quality of emergency care for children. This proposal will develop an emergency care visit registry for pediatric patients from HER clinical data which will serve as the foundation for the current and future studies, precluding the need for resource-intensive chart review. Emergency care performance measures will be derived from registry data and we will measure variability among sites and individual clinicians. Data from the registry and qualitative methods will be used to set benchmarks of care. We will design site- and clinician-level Quality Performance Measure Report Cards that will be generated from the registry and distributed monthly.The registry will be utilized to evaluate the performance measures in a prospective manner for improvement in the measures themselves as well as decreased variation in perform