Applying Institute of Medicine quality domains to measure pediatric community health

Objective: To measure quality of health in the community by defining a framework for assessing the impact of community medicine programs, based on the six Institute of Medicine's (IOM) quality domains.

Methods: An extensive needs assessment was conducted by the Children's Hospital Boston. The community identified four major issue areas: mental health, asthma, obesity and injury. Based on the need, quality measures were defined to measure progress. Broad measures were designed to assess outcomes and to indicate where improvements may best be targeted in future by establishing benchmarks.

Results: The table below summarizes the measurement framework, indicating those measures currently developed:

The measures are defined as: Effectiveness: measured by the number of emergency department visits and admissions for children in an asthma case-management program. Efficiency: cost of emergency room visits and admissions relating to patients in the asthma program. Equitability: measured ensuring children with raised BMI are referred equally for intervention based on race and gender. Safety: Injury rates for children in defined neighborhoods. Timeliness by the time from referral to appointment to a mental health program. Patient centered (community centered): increased participation from the community in program planning and implementation.

Conclusion: This is a unique effort to utilize the IOM quality indicators to measure community health and setup benchmarks for the future. The outcome and process measures for each identified community need will be used to assess models and best practices.