Implementation of an Outcome Measure in Pediatric Behavioral Health: A Process Improvement Initiative

Efforts to monitor outcomes in pediatric behavioral health are becoming a quality, financial, and regulatory imperative. The implementation of a broad-based measure to assess patient functioning at the start of pediatric psychology services, as well as at subsequent visits, has not been demonstrated. This article describes the systematic implementation of a measure of health-related quality of life (HRQOL) to assess functional impairment across an entire clinic population using quality improvement science and methodologies.

The Pediatric Quality of Life Inventory Generic Core 4.0 (PedsQL) was administered at initial and subsequent visits for all patients seeking treatment at a large, tertiary care pediatric psychology clinic in an academic pediatric medical center (Nationwide Children's Hospital, Columbus, Ohio). The goal of this project was to design a process change to support a 90% completion rate of this measurement tool by all clinicians.

Within 16 months, the completion rate of the PedsQL increased from a baseline of 39% to the identified goal of 90%. This process change was within control limits (over 80%) for over 12 months.

This study demonstrates the implementation of a systematic process for collection of outcome measures in a pediatric behavioral health care setting. Successful administration of an outcome measure at multiple time points during the care of children and adolescents in a large psychology clinic can allow for quantitative assessment of treatment progress and identify a pathway for administration of additional measures.