title: Emergency department quality: an analysis of existing pediatric measures.
abstract: OBJECTIVE
  The Institute of Medicine (IOM) has recommended the development of national standards for the measurement of emergency care performance. The authors undertook this study with the goals of enumerating and categorizing existing performance measures relevant to pediatric emergency care.
  
  
  METHODS
  Potential performance measures were identified through a survey of 1) the peer-reviewed literature, 2) websites of organizations and societies pertaining to quality improvement, and 3) emergency department (ED) directors. Performance measures were enumerated and categorized, using consensus methods, on three dimensions: 1) the IOM quality domains; 2) Donabedian's structure/process/outcome framework; and 3) general, cross-cutting, or disease-specific measures.
  
  
  RESULTS
  A total of 405 performance measures were found for potential use for pediatric emergency care. When categorized by IOM domain, nearly half of the measures were related to effectiveness, while only 6% of measures addressed patient-centeredness. In the Donabedian dimension, 67% of measures were categorized as process measures, with 29% outcome and 4% structure measures. Finally, 31% of measures were general measures relevant to every ED visit. Although 225 measures (55%) were disease-specific, the majority (56%) of these measures related to only five common conditions.
  
  
  CONCLUSIONS
  A wide range of performance measures relevant to pediatric emergency care are available. However, measures lack a systematic and comprehensive approach to evaluate the quality of care provided.
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center (EA, KV), OH, USA. evaline.alessandrini@cchmc.org
authors.forename: Evaline
authors.initials: E
authors.lastname: Alessandrini
authors.forename: Kartik
authors.initials: K
authors.lastname: Varadarajan
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Alpern
authors.forename: Marc H
authors.initials: MH
authors.lastname: Gorelick
authors.forename: Kathy
authors.initials: K
authors.lastname: Shaw
authors.forename: Richard M
authors.initials: RM
authors.lastname: Ruddy
authors.forename: James M
authors.initials: JM
authors.lastname: Chamberlain
mesh_terms: D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D020407:Internet; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D014481:United States