JANUARY 1999
“Most of the things that happen to children don’t happen in the healthcare system,” Boston’s Homer points out. “They happen in school, day care and at home. Quality improvement for kids’ health has to focus more on the interface between healthcare and these other systems. That means forming alliances, and hospitals have engaged in a variety of partnerships. Texas Children’s, for example, works with churches and other groups to distribute car seats for infants and educate parents and children on safety, issues, such as the use of bicycle helmets,” says Vice President Douglas Hock. Children’s in San Diego has 38 programs with several local schools, including a school -based health center, Kurtin says. (According to the National Assembly on School-Based Health Care Centers, there are more than 1,100 school-based health centers in the United States; however, a survey by the Robert Wood Johnson Foundation’s “Making The Grade” program indicates that only 20% of these centers are sponsored by a hospital. The rest are sponsored by community health centers, public health departments, community-based organizations, school healthcare organizations and school districts.)
Although collaboration between pediatric care providers and other community organizations is important, it is often difficult to achieve in any meaningful way, mainly because of lack of funding, notes Elizabeth A. McGlynn, Ph.D., director of the Center for Research on Quality in Health Care for RAND. “The education system, for example, is as burdened as the healthcare system,” she says. “In California, we have lots of school districts where the kids don’t have textbooks because there’s no money to buy them.”
Under a multidisciplinary, community service and leadership training program based at Boston Medical Center, undergraduates at Harvard University and the Massachusetts Institute of Technology work with physicians, lawyers and other professionals to improve the health and development of inner-city children and their families. Rebecca Onie, founder and director of Project HEALTH (for Helping Empower, Advocate & Lead Through Health), says one of its most successful programs targets asthma by engaging children in after-school swimming, combined with asthma education. Peak flow has improved about 22% among children who participate in the swim program, “which is about four times as effective as the most effective asthma medication,” Onie says. When the program started, she adds, none of the children could swim three strokes; by the program’s end, 80% could. Project HEALTH also runs a fitness and nutrition program for overweight and obese girls, a disease education program for children with sickle cell disease, and programs in accident prevention and child safety. University students also act as advocates for families, helping them navigate the healthcare system and teaching them how to get the services they need for their children.
Key to Project HEALTH’s success is the support of physicians, who work with the students to make sure the programs “meet real medical needs,” says Onie. Hoping to build on its results, Project HEALTH is testing a new collaboration at Brown University that will gauge the extent to which the programs developed in Boston can be applied in the Providence area. “This will give us an opportunity to see what top grams can be replicated in other settings and which ones need to be modified,” Onie notes.
Although important advances are being made in the area of child health services research and pediatric care providers are increasing their own QI activities – both internal and collaborative – a great deal of work remains to improve health service delivery for children, according to researchers and child health advocates. Some suggest that the best strategy lies in convincing stakeholders – insurers, policymakers and providers – that improving care for children is a long-term investment. “In cost-effectiveness terms, children always lose, because they are considered to be a low ticket,” says Sherrie H. Kaplan, Ph.D., MPH, co-direc