Seminars in pediatric surgery
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Improvement in anesthesia outcomes has derived from advances in safety science related to equipment, drugs, human factors analysis, professional standardization and organization, subspecialty care, and regionalization. Outcomes of pediatric anesthesia have improved, but universal outcome measures are lacking. Because of the limitations of small numbers, future improvement efforts will necessarily involve multiple disciplines, institutions, and regions, and will require sophisticated systems approaches.
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Variation in clinical practice patterns has attracted the attention of specialty organizations, payers, government health agencies, and the public. Such variation raises concerns about efficacy and cost relative to the care provided. Consequently, the establishment of national benchmarks has become an increasing priority in trauma care as well as elsewhere in the health sector. ⋯ This report will highlight outcomes studies in pediatric trauma care, often comparing outcomes by physician and hospital expertise. We will discuss pediatric trauma mortality and outcomes in abdominal, closed head, and orthopedic injuries with an emphasis on functional outcomes. Much of the data are derived from large regional and national databases, which are increasingly available and useful in the analysis of specific aspects of our health care delivery system.
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Semin. Pediatr. Surg. · May 2008
Developing a NSQIP module to measure outcomes in children's surgical care: opportunity and challenge.
Under the guidance of the American College of Surgeons (ACS) and in partnership with the US Department of Veterans Affairs (VA), the National Surgical Quality Improvement Program (NSQIP) has been developed to improve the quality of surgical care in adults on a national level. Its purpose is to provide reliable, risk-adjusted outcomes data so that surgical quality can be assessed and compared between institutions. Data analysis consists of reporting observed to expected ratios (O/E) for 30-day postoperative mortality and morbidity measurements. ⋯ In 2005, a planning committee was formed by the ACS and the American Pediatric Surgical Association to explore the development of a children's surgery NSQIP module. In conjunction with the Colorado Health Outcomes Program at the University of Colorado, a program potentially applicable to all children's surgical specialties has been designed. This manuscript describes the development of that Children's ACS-NSQIP module.