Thoughts on the Modern Practice of Pediatrics

Abstract

As chief of three pediatric services in three quite different cities—New Haven, Brooklyn, and Rochester, New York—I have been involved in studies related to quality assurance issues. Although the studies have been hospital based, some inpatient and some outpatient, I believe that extrapolations to the office practice of pediatrics are legitimate. A review of some of these and related studies by others of the quality of the medical care of children; some highlighting of major problems and thus challenges for future pediatric care; and some recommendations will be the subjects of this report. Major underlying theses will be (1) that there is a serious gap between what we know should be done for children and what we do, (2) that this has serious quality and cost consequences, and (3) that we are not using modern information processing and analysis techniques to assist in improving the quality of care in either hospital or office settings. Finally, I will make some suggestions about how the knowledge-performance gap might be reduced.