Accreditation of Medical Transport Systems. Each of these organizations collects performance information.

However, many performance measurement efforts have two major shortcomings. First, many such efforts do not specifically address pediatric performance measures. As discussed in Chapter 5, it is critical that information systems incorporate specific attributes of pediatric illness and injury. Second, the measures developed cannot be used to assess the performance of the full emergency care system within each community and benchmark that performance against statewide and national performance metrics. A credible entity to develop such measures would not be strongly tied to any one component of the emergency care continuum. One approach would be to form a collaborative entity that would include representation from all of the system components—hospitals, trauma centers, EMS agencies, physicians, nurses, and others. Certainly individuals with pediatric expertise must be involved as well.

Another approach would be to work with an existing organization, such as the National Quality Forum (NQF), to develop a set of emergency care–specific measures. NQF grew out of the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. It operates as a not-for-profit membership organization made up of national, state, regional, and local groups representing consumers, public and private purchasers, employers, health care professionals, provider organizations, health plans, accrediting bodies, labor unions, supporting industries, and organizations involved in health care research or quality improvement. NQF has reviewed and endorsed measure sets applicable to several health care settings and clinical areas and services, including hospital care, home health care, nursing-sensitive care, nursing home care, cardiac surgery, and diabetes care (NQF, 2002, 2003, 2004a,b, 2005).

The committee concludes that a standard national approach to the development of performance indicators is essential and recommends that the Department of Health and Human Services convene a panel of individuals with emergency and trauma care expertise to develop evidence-based indicators of emergency and trauma care system performance, including the performance of pediatric emergency care (3.3). The federal government must play a lead role in this effort because of the need for an independent, national process involving the broad participation of every component of emergency care. The Department of Health and Human Services (DHHS) should fund the process and convene the panel of individuals with emergency and trauma care expertise to review the research and develop performance indicators. The committee intends this to be a discrete project to be conducted within a brief timeframe. The set of performance indicators should be selected within 18 months of the release of this report.

The measures developed should include structure and process measures,



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