Measuring How Healthcare Impacts Children

Dr. Rita Mangione-Smith develops innovative ways to pinpoint which medical treatments, procedures and practices improve patients’ lives, and which ones need improvement.

Comparing quality of life before and after care

Mangione-Smith spearheaded implementation of a survey, called the PedsQL, that is part of Seattle Children’s Outcomes Assessment Program. The survey is given to all families who provide consent when their child enters Seattle Children’s Hospital and then again after they go home. The survey asks before-and-after questions about how the child is doing physically, mentally and emotionally. By identifying whether care improves a child’s quality of life, this helps the hospital team see where it needs to rethink what it does – and provides a tool that could be used by hospitals nationwide.

Improving care coordination for complex conditions

In 2011, Mangione-Smith received a four-year, $8 million Center of Excellence grant from the Agency for Healthcare Research and Quality to develop ways to measure quality of care for children with complex chronic disease including mental health problems.

Children with multiple conditions like developmental delay, cerebral palsy or congenital heart disease often need care from multiple providers in different locations. When those providers do a good job coordinating their efforts, patients spend less time in the hospital and their quality of life improves. When coordination is poor, a child’s health problems can spiral out of control.

Through this grant, Mangione-Smith brought together experts from eleven institutions including Seattle Children’s, the RAND Corporation, Kaiser Permanente, the Community Pediatric Foundation of Washington, the Washington Department of Social and Health Services, the Minnesota Department of Human Services, Minnesota Academy of Pediatrics Foundation, Family Voices of Minnesota, Cincinnati Children’s Hospital Medical Center and Children’s Hospital of Los Angeles.

Together, they developed ways to measure whether high-quality care coordination is happening. Their quality of care measures will be used by large public insurers including Medicaid. This could have a significant impact at a time when insurers are starting to require that providers measure care quality and achieve specific benchmarks in order to be reimbursed.

Investigating respiratory illness outcomes

Mangione-Smith and her colleagues recently developed and pilot tested a measurement tool – the Pediatric Respiratory Illness Measurement System (PRIMES) – that assesses quality of care for four respiratory illnesses commonly seen in hospitals: asthma, bronchitis, croup and community-acquired pneumonia.

As part of the tool, PRIMES outlines standardized care that physicians should follow for these illnesses in the emergency department and inpatient settings. The research team is studying how adhering to PRIMES affects quality of life and cost of care for study participants at five hospitals: Seattle Children’s Hospital, Children’s Hospital of Philadelphia, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Texas Children’s Hospital and Children’s Hospital Colorado.

The study will improve understanding of the relationship between adhering to recommended standards of care in pediatrics and health care outcomes. PRIMES could eventually be used to identify areas of respiratory illness care where quality improvement efforts are most needed and provide valid performance comparisons across hospitals caring for children.

This work is funded by the National Heart, Lung and Blood Institute.

Investigator Biography

Rita M. Mangione-Smith, MD, MPH

Dr. Rita Mangione-Smith is an investigator in the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute; a professor and chief of the Division of General Pediatrics in the University of Washington Department of Pediatrics; and director of the Quality of Care Research Fellowship at the University of Washington Department of Pediatrics and Seattle Children’s Hospital.