title: Categorization of National Pediatric Quality Measures.
abstract: OBJECTIVE
  The number of quality measures has grown dramatically in recent years. This growth has outpaced research characterizing content and impact of these metrics. Our study aimed to identify and classify nationally promoted quality metrics applicable to children, both by type and by content, and to analyze the representation of common pediatric issues among available measures.
  
  
  METHODS
  We identified nationally applicable quality measure collections from organizational databases or clearinghouses, federal Web sites, and key informant interviews and then screened each measure for pediatric applicability. We classified measures as structure, process, or outcome using a Donabedian framework. Additionally, we classified process measures as targeting underuse, overuse, or misuse of health services. We then classified measures by content area and compared disease-specific metrics to frequency of diagnoses observed among children.
  
  
  RESULTS
  A total of 386 identified measures were relevant to pediatric patients; exclusion of duplicates left 257 unique measures. The majority of pediatric measures were process measures (59%), most of which target underuse of health services (77%). Among disease-specific measures, those related to depression and asthma were the most common, reflecting the prevalence and importance of these conditions in pediatrics. Conditions such as respiratory infection and otitis media had fewer associated measures despite their prevalence. Other notable pediatric issues lacking associated measures included care of medically complex children and injuries.
  
  
  CONCLUSIONS
  Pediatric quality measures are predominated by process measures targeting underuse of health care services. The content represented among these measures is broad, although there remain important gaps.
authors.affiliation: Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; samantha.a.house@hitchcock.org.|Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire.
authors.forename: Samantha A
authors.initials: SA
authors.lastname: House
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah; and.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Coon
authors.affiliation: Department of Pediatrics, Stanford University, Stanford, California.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Schroeder
authors.affiliation: Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.|Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire.
authors.forename: Shawn L
authors.initials: SL
authors.lastname: Ralston
mesh_terms: D002648:Child; D002662:Child Health Services / Q000592:standards*; D006801:Humans; D010372:Pediatrics / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*