Quality of care in pediatrics and health disparities: The increasing role of quality improvement science

Despite well documented disparities in health and health care, little is known about what types of interventions have the potential to ameliorate disparities [1]. Many clinical providers, organizations, and policy makers do not know where and how to target efforts towards addressing disparities. Innovate approaches are needed to address health disparities and ensure that every child has access to high quality care. Quality improvement (QI) provides one such approach given its demonstrated effectiveness in improving general outcomes in the health care setting. QI can be defined as “a multidisciplinary, systems-focused, data driven method of understanding and improving the efficiency, effectiveness, and reliability of health processes and outcomes of care” [2]. It consists of continuous actions that aim to measurably improve health care services and the health status of targeted patient groups by improving uptake of evidence-based, best practices into clinical care [3]. Multiple QI frameworks exist [2]. Example approaches include Plan, Do, Study, Act (PDSA), Total Quality Management (TQM), Continuous Quality Improvement (CQI), Business Process Reengineering (BPR), rapid cycle change, lean thinking, Six Sigma, and Focus, Analyze, Develop, Execute/Evaluate (FADE). Although the evidence isn’t clear on which specific approach works best, all of these models are effective in elucidating a health care organization’s current state, determining areas for improvement, designing and implementing a sequential and iterative strategy to achieve improvement, and subsequently collecting data to monitor progress and adjust the strategy as indicated over time [4, 5]. The ongoing process of QI requires four elements: performance goals, performance measures, QI practices, and feedback and reporting.