Quality and Safety in Pediatric Complex Care

In parallel with the evolving recognition of children with medical complexity (CMC) as a specific and important population over the last decade, there has been a simultaneous increase in interest in healthcare quality. This article provides a theoretical overview of healthcare quality followed by a focused review of aspects of quality as they specifically pertain to the care of CMC. The importance of considering the full spectrum from the larger political and economic environment to the individual clinical microsystem is emphasized. Issues around measurement for the purpose of quantifying and improving healthcare quality are addressed, with a brief examination of emerging quality measures specifically for pediatrics and CMC. The Model for Improvement, a method for conducting formal quality improvement is described, and the distinction between this type of approach and traditional biomedical research is explained. A framework for addressing specific domains of healthcare quality is outlined, including safety, timeliness, efficacy, efficiency, equitability, and family-centredness. Challenges with delivering high quality healthcare specific to CMC are detailed, and corresponding specific interventions are described, drawing from an extensive literature review and from our own local experience. Areas of emphasis include barriers to access to appropriate care for CMC, the role of care coordination, hospital care of CMC (recognition of the deteriorating child, medication safety, and care of the child with technology dependence), and the burden of care for families of CMC. Gaps in current knowledge are addressed and recommendations for future research and practice are put forth.