Health care quality-improvement approaches to reducing child health disparities.
Health care quality-improvement approaches to reducing child health disparities.
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DOI：
10.1542/peds.2009-1100k
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发表时间：
2009-11
期刊：
影响因子：
8
通讯作者：
Burnet DL
中科院分区：
文献类型：
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作者：
Chin MH;Alexander-Young M;Burnet DL
旨在减少不同种族、民族、社会经济地位和保险状况的儿童护理和结果差异的质量改进工作相对较少。为了为减少儿童健康差异的质量改进工作提供信息，我们总结了从成人差异干预文献中吸取的经验教训，确定了减少儿童哮喘结果和免疫率差异的干预措施，并概述了儿童差异干预措施的特殊考虑因素。对提供者、医疗保健组织和研究人员的主要建议包括：(1) 根据保险状况、种族/族裔、语言和社会经济状况分层检查您的绩效数据； (2) 衡量和改善儿童健康相关的生活质量、发育和针对具体情况的目标（例如哮喘和免疫接种）； (3) 衡量和改进早期预防疾病（如伤害、暴力、药物滥用和性传播疾病）的预期指导和促进积极增长的努力（如提高低识字率的读者计划）； (4) 衡量和改善影响儿童健康结果并减少差异的护理结构，例如以患者为中心的医疗之家要素； (5) 将家庭纳入干预措施； (6) 使用多学科团队对患者进行密切跟踪和随访； (7) 将非医疗保健合作伙伴纳入质量改进干预措施； (8) 在文化上定制质量改进。对付款人的一个重要建议是调整财政激励措施以减少差距。美国国立卫生研究院和其他资助者应支持（1）根据这些建议进行差异干预研究，分析临床结果、干预实施过程和成本，以及（2）创建新的儿童健康服务研究人员，他们可以找到减少差异的有效质量改进方法。
Relatively few quality-improvement efforts have been aimed at reducing differences in children’s care and outcomes across race and ethnicity, socioeconomic status, and insurance status. To inform quality-improvement efforts to reduce child health disparities, we summarize lessons learned from the adult disparities-intervention literature, identify interventions that have reduced disparities in pediatric asthma outcomes and immunization rates, and outline special considerations for child disparity interventions. Key recommendations for providers, health care organizations, and researchers include: (1) examine your performance data stratified according to insurance status, race/ethnicity, language, and socioeconomic status; (2) measure and improve childhood health-related quality of life, development, and condition-specific targets (such as asthma and immunizations); (3) measure and improve anticipatory guidance for early prevention of conditions (such as injuries, violence, substance abuse, and sexually transmitted diseases) and efforts to promote positive growth (such as readership programs to improve low literacy); (4) measure and improve structural aspects of care that affect child health outcomes and can reduce disparities, such as patient-centered medical-home elements; (5) incorporate families into interventions; (6) use multidisciplinary teams with close tracking and follow-up of patients; (7) integrate non–health care partners into quality-improvement interventions; and (8) culturally tailor quality improvement. A key recommendation for payers is to align financial incentives to reduce disparities. The National Institutes of Health and other funders should support (1) disparity-intervention studies on these recommendations that analyze clinical outcomes, intervention-implementation processes, and costs, and (2) creation of new child health services researchers who can find effective quality-improvement approaches for reducing disparities.