The James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
Pediatrics. 2013 Jun;131 Suppl 4:S189-95. doi: 10.1542/peds.2012-3786E.
Multiple gaps exist in health care quality and outcomes for children, who receive <50% of recommended care. The American Board of Pediatrics has worked to develop an improvement network model for pediatric subspecialties as the optimal means to improve child health outcomes and to allow subspecialists to meet the performance in practice component of Maintenance of Certification requirements. By using successful subspecialty initiatives as exemplars, and features of the Institute for Healthcare Improvement's Breakthrough Series model, currently 9 of 14 pediatric subspecialties have implemented collaborative network improvement efforts. Key components include a common aim to improve care; national multicenter prospective collaborative improvement efforts; reducing unnecessary variation by identifying, adopting, and testing best practices; use of shared, valid, high-quality real-time data; infrastructure support to apply improvement science; and public sharing of outcomes. As a key distinguisher from time-limited collaboratives, ongoing pediatric collaborative improvement networks begin with a plan to persist until aims are achieved and improvement is sustained. Additional evidence from within and external to health care has accrued to support the model since its proposal in 2002, including the Institute of Medicine's vision for a Learning Healthcare System. Required network infrastructure systems and capabilities have been delineated and can be used to accelerate the spread of the model. Pediatric collaborative improvement networks can serve to close the quality gap, engage patients and caregivers in shared learning, and act as laboratories for accelerated translation of research into practice and new knowledge discovery, resulting in improved care and outcomes for children.
儿童的医疗保健质量和结果存在多个差距，他们仅接受了<50%的推荐护理。美国儿科学会一直致力于为儿科亚专业开发一种改进网络模型，因为这是改善儿童健康结果并使亚专科医生能够满足维持认证要求中实践表现部分的最佳手段。通过将成功的亚专业举措作为范例，并采用医疗改进研究所突破性系列模型的特点，目前已有 14 个儿科亚专业中的 9 个实施了协作网络改进工作。关键组成部分包括改善护理的共同目标；全国多中心前瞻性协作改进努力；通过确定、采用和测试最佳实践来减少不必要的差异；使用共享、有效、高质量的实时数据；应用改进科学的基础设施支持；以及公开分享结果。作为与限时协作的主要区别，正在进行的儿科协作改进网络从一个计划开始，该计划将持续到目标实现和改进持续为止。自 2002 年提出该模型以来，来自医疗保健内部和外部的更多证据支持了该模型，包括医学研究所对学习医疗保健系统的愿景。已经明确了所需的网络基础设施系统和功能，可用于加速该模型的推广。儿科协作改进网络可以弥合质量差距，使患者和护理人员共同参与学习，并作为加速将研究转化为实践和新知识发现的实验室，从而改善儿童的护理和结果。
