Division of General and Community Pediatrics and
James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
Pediatrics. 2020 Jan;145(1). doi: 10.1542/peds.2019-1531.
Pediatricians aspire to optimize overall health and development, but there are no comprehensive measures of well-being to guide pediatric primary care redesign. The objective of this article is to describe the Cincinnati Kids Thrive at 5 outcome measure, along with a set of more proximal outcome and process measures, designed to drive system improvement over several years. In this article, we describe a composite measure of "thriving" at age 66 months, using primary care data from the electronic health record. Thriving is defined as immunizations up-to-date, healthy BMI, free of dental pain, normal or corrected vision, normal or corrected hearing, and on track for communication, literacy, and social-emotional milestones. We discuss key considerations and tradeoffs in developing the measure. We then summarize insights from applying this measure to 9544 patients over 3 years. Baseline rates of thriving were 13% when including all patients and 31% when including only patients with complete data available. Interpretation of results was complicated by missing data in 50% of patients and nonindependent success rates among bundle components. There was considerable enthusiasm among other practices and sectors to learn with us and to measure system performance using time-linked trajectories. We learned to present our data in ways that balanced aspirational long-term or multidisciplinary goal-setting with more easily attainable short-term aims. On the basis of our experience with the Thrive at 5 measure, we discuss future directions and place a broader call to action for pediatricians, researchers, policy makers, and communities.
儿科医生致力于优化整体健康和发育，但目前还没有全面的健康衡量标准来指导儿科初级保健的重新设计。本文的目的是描述辛辛那提儿童 5 岁茁壮成长（Cincinnati Kids Thrive at 5）的结果衡量标准，以及一组更接近的结果和过程衡量标准，旨在在几年内推动系统的改进。在本文中，我们描述了使用电子健康记录中的初级保健数据来衡量 66 个月大儿童“茁壮成长”的综合指标。茁壮成长被定义为疫苗接种及时、健康体重指数（BMI）、无牙痛、正常或矫正视力、正常或矫正听力以及在沟通、读写和社会情感里程碑方面进展顺利。我们讨论了开发该衡量标准的关键考虑因素和权衡取舍。然后，我们总结了在 3 年内对 9544 名患者应用该衡量标准的结果。当包括所有患者时，茁壮成长的基线率为 13%，当包括仅具有完整可用数据的患者时，茁壮成长的基线率为 31%。由于 50%的患者存在数据缺失且捆绑组件的成功率不独立，结果的解释变得复杂。其他实践和部门对与我们一起学习并使用时间关联的轨迹来衡量系统绩效表现表现出了极大的热情。我们学会了以平衡有抱负的长期或多学科目标设定与更易于实现的短期目标的方式来展示我们的数据。基于我们在 Thrive at 5 衡量标准方面的经验，我们讨论了未来的方向，并呼吁儿科医生、研究人员、政策制定者和社区采取行动。
