Moving From Child Health Care to Child Health

Moving From Child Health Care to Child Health 1024 575 Kelly Kelleher, MD, MPH

As pediatricians, we want children to be healthier, even the ones who never come through our doors. At Nationwide Children’s Hospital, the board and leadership have aimed to do just that by setting the highest bar yet for our organization – we want central Ohio children to be the healthiest in the United States.

But what does that mean? How do we measure it? And how can Nationwide Children’s change health for so many children who are not patients? What are we, as a pediatric institution, accountable for beyond health care?

Traditionally, Nationwide Children’s measured quality and clinical outcomes of specific health care services they way other hospitals do, by considering the volume of services delivered and the safety/quality of those services. Such measures are especially important for children and adolescents (and their families) with severe and persistent diseases where appropriate and timely services are the difference between life and death. As a result, our quality measures for particular diseases are, for the most part, outstanding.

Unfortunately, clinical services do not address many of the problems children, adolescents and their families currently face. A torrent of new research confirms what our clinicians and staff already know – medical care can do little for common conditions brought about by poverty and other social determinants of health in some of our neighborhoods. Every day in our practices, physicians are confronted with families battling violence, housing insecurity, food insecurity and challenged schools.

The consequences of these social determinants are devastating. While our safety and medical quality measures are outstanding, community rates of asthma, adolescent suicide, infant mortality and other diseases driven by social determinants are high and sometimes rising.

Nationwide Children’s has already been a leader in innovative practices to address social determinants through the Healthy Neighborhoods Healthy Family initiative, the Ohio Better Birth Outcomes initiative and our School Care Connection programs, among others. However, that work has underscored the need to measure our progress in these community health initiatives and programs as we do in all areas of our work.

Beginning two years ago, Steve Allen, MD, chief executive officer at Nationwide Children’s, and Richard Brilli, MD, chief medical officer at Nationwide Children’s, led two small gatherings of national leaders in pediatrics to discuss what types of measures would better capture not just pediatric health care delivery but, more importantly, the health of the children in the community. It was clear that measures would have to address the health of patients and the health of all children in the community.

At the same time these leadership meetings were taking place, the National Academy of Medicine published their Vital Signs for Healthcare, a call for a dramatic simplifying of health care accountability measures and the inclusion of community health measures as part of health systems accountability. As part of the original document, the Vital Signs committee noted that children and adolescents would need special attention in designing accountability measures because of their rapid development, susceptibility to physical and social environmental influences, and regional health care systems. After a period of negotiations, pediatric leadership organizations nationally have embraced the Vital Signs framework and are preparing a child-focused response to the original Vital Signs document.

The convening of the National Academy of Medicine, the Children’s Hospital Association, the American Academy of Pediatrics, and other major organizations will take time and patience. Meanwhile, Nationwide Children’s is already planning to test some of the measures that have been proposed in early discussions, such as teen pregnancy rate, high school graduation rate and infant mortality rate. Nationwide Children’s is a logical leader for this work because of size, dominance in the local pediatric market, access to Partners For Kids data and expertise with community health activities. Partners for Kids is one of the oldest and largest accountable care organizations in the country.

Dr. Brilli will be leading a multidisciplinary team to develop these potential measures of health for Franklin County children, baseline data and key driver diagrams with possible improvement activities. Early candidates for measures beyond those listed above include teen tobacco use, a preventive services composite, kindergarten readiness and an outpatient harm index. This plan will be the first of its kind for a childrens hospital, and more importantly, it offers a roadmap from being a provider of health care to a partner in producing health for central Ohio children.

Of course, we do not face improving these measures alone. The Mayor’s Office, the United Way, Goodwill Industries, Community Development For All People – a faith-based non-profit community development organization – and many others are with us at each step knowing that this work will take years and resources. But the opportunity to shift the focus from health care to health is too good to pass up, and the staff at Nationwide Children’s has delivered time and again on aspirational goals.

About the author

Dr. Kelleher is a pediatrician whose research interests focus on accessibility, effectiveness and quality of health care services for children and their families, especially those affected by mental disorders, substance abuse or violence. He has a longstanding interest in formal outcomes research for mental health and substance abuse services. Dr. Kelleher is director of the Center for Innovation in Pediatric Practice and vice president of Health Services Research at The Research Institute at Nationwide Children’s Hospital. Dr. Kelleher is also professor in the Department of Pediatrics of The Ohio State University College of Medicine.