Measuring Quality and Testing Interventions to Improve Pediatric Healthcare

Dr. Rita Mangione-Smith develops innovative ways to pinpoint which medical treatments, procedures and practices improve patients’ health outcomes, and which ones need improvement. Her research team then designs and tests interventions to make care better for children across clinical settings.

Improving Communication During Pediatric Visits for Acute Respiratory Infections

Development and testing of the Dialogue Around Respiratory Illness Treatment (DART) quality improvement program

The Mangione-Smith Lab has spent over a decade studying how doctor–parent communication influences the decision to prescribe antibiotics for acute respiratory illness in the pediatric outpatient setting. Based on the findings of this research and under funding from the Eunice Kennedy National Institute for Child Health and Human Development (NICHD), Mangione-Smith and colleagues have developed a multifaceted quality improvement (QI) intervention for outpatient providers called Dialogue Around Respiratory Illness Treatment (DART). The DART QI program focuses on optimizing communication with families during visits for acute respiratory infection in order to avoid unnecessary antibiotic prescribing.

The research team is currently conducting a trial of the DART QI intervention in 20 pediatric practices across the nation in collaboration with the American Academy of Pediatrics Pediatric Research in Office Settings Network (PROS) and the NorthShore Health System in Chicago to determine DART’s effectiveness in reducing overall antibiotic prescribing for respiratory illness in the pediatric outpatient setting.

  • Online tutorial modules for the DART program are publicly available on our DART Learning Modules page.

Improving Care Transitions and Mental Healthcare for Hospitalized Children

In 2016, Mangione-Smith received a four-year grant from the Agency for Healthcare Research and Quality to assess the quality of care received by hospitalized children, including those admitted with mental health problems.

Through this grant, Mangione-Smith brought together researchers and quality improvement experts across eight hospitals providing care to children nationally, including Seattle Children’s Hospital, UCSF Benioff Children’s Hospital, University of Iowa Children’s Hospital, Children’s Hospital Colorado, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Cincinnati Children’s Hospital, Mount Sinai Hospital in New York City and Medical University of South Carolina Children’s Hospital.

Together, using two quality measure sets developed by the Mangione-Smith research team – one focused on the quality of hospital-to-home transitions and one focused on the quality of inpatient mental healthcare – this group of hospitals is working to develop interventions to improve care for children.

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 our 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.

Comparing Quality of Life Before and After Hospitalization

In 2009, Mangione-Smith spearheaded implementation of a survey, called the PedsQL, by developing Seattle Children’s Outcomes Assessment Program (those on Seattle Children’s network may search for “OAP” on CHILD). The survey is given to families who provide consent when their children are admitted to Seattle Children’s Medical, Surgical, Rehabilitation or Psychiatry and Behavioral Medicine Units and then again after they go home. The survey asks before-and-after questions about how the child is doing physically, emotionally and socially. 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 method to assess patient-centered outcomes that could be used by hospitals nationwide.

Investigator Biography


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