Transcript Clinical Decision Making - Center for Health and Health

Patient Safety and Quality:
Where Does Health Care in
Schools Fit In?
Howard Bauchner, M.D.
Professor of Pediatrics & Public Health
Director, Division of General Pediatrics
Boston University School of Medicine
Boston Medical Center
Editor-in-Chief
Archives of Disease in Childhood
Talking Points
Quality
 Medication and
Safety
 School Agenda
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– Clinical
– Research
– Policy
Quality
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“Doing the right thing, at the right time, in the
right way, for the right person, and having the
best possible results”
Balancing over use and under use and
avoiding misuse
Schools – provide an enormous amount of
treatment (medication) and ongoing
monitoring of children with chronic disease
Quality (CHASM Report)
Safety
Effective
Efficient
Timely
Equity
Patient-Centered
Quality (for AHRQ)
Medical Errors
Effective
Efficient
Timely
Equity
Patient-Centered
Quality (for NCQA)
Medical Errors
Effective
Efficient
Timely
Equity
Patient-Centered
Quality (for social justice)
Medical Errors
Effective
Efficient
Timely
Equity
Patient-Centered
Patient Safety
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Refers to absence or reduction of injury
associated with healthcare delivery to
patients – patient safety can result from
the avoidance of medical errors or from
actions to prevent errors
Medical Errors
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“Mistakes made in the process of care that result in,
or have the potential to, result in harm to patients”
“Medical errors can result from an action that is taken
(error of commission) or an action that is not taken
(error of omission)”
May relate to diagnosis (missed, delayed, incorrect);
treatment (incorrect therapy or dose, delayed or
omitted drug); preventive services (inappropriate,
delayed, omitted)
Emphasis has been on medication errors
Medication Errors
“Preventable inappropriate use of
medication including prescribing,
dispensing, and administering”
 Adverse event – “an untoward,
unintended (usually), and unanticipated
(usually) outcome that occurs in
association with health care”

Patient Safety
Emphasis on inpatient issues
 Little known about ambulatory arena
 Emphasis been on medication errors,
rather medical errors or errors of
commission or omission
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School Health
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Is school health a good thing?
Can you prove it is a good thing?
How do we make it part of the health care
community (valued by stakeholders)?
Medication errors are likely to be rare!
Potential impact on quality may be high
Once part of the health care community it is
subject to all of the same issues
– Quality, efficiency, timeliness, equity,
safety, patient-centeredness
Clinical Conditions to Consider
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Diseases that are prevalent, require ongoing
monitoring/therapy, high morbidity
Asthma – help make diagnosis, monitor
disease, assist in use of medications correctly
Type 2 obesity – help with diagnosis and
management, including medication
Type 1 obesity – help with management,
including medication
Immunizations – maybe critically important
ADHD – has evolved because of qd dosing
Conclusion
School health is a huge enterprise
 It is incumbent upon its advocates to
show that it benefits students
 Medication management is part of the
quality revolution (effectiveness,
timeliness)
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