2. 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

3. Talking Points l Quality l Medication and Safety l School Agenda –Clinical –Research –Policy

4. Quality l “Doing the right thing, at the right time, in the right way, for the right person, and having the best possible results” l Balancing over use and under use and avoiding misuse l Schools – provide an enormous amount of treatment (medication) and ongoing monitoring of children with chronic disease

5. Quality (CHASM Report)

6. Quality (for AHRQ)

7. Quality (for NCQA)

8. Quality (for social justice)

10. Patient Safety l 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

11. Medical Errors l “Mistakes made in the process of care that result in, or have the potential to, result in harm to patients” l “Medical errors can result from an action that is taken (error of commission) or an action that is not taken (error of omission)” l May relate to diagnosis (missed, delayed, incorrect); treatment (incorrect therapy or dose, delayed or omitted drug); preventive services (inappropriate, delayed, omitted) l Emphasis has been on medication errors

12. Medication Errors l “Preventable inappropriate use of medication including prescribing, dispensing, and administering” l Adverse event – “an untoward, unintended (usually), and unanticipated (usually) outcome that occurs in association with health care”

13. Patient Safety l Emphasis on inpatient issues l Little known about ambulatory arena l Emphasis been on medication errors, rather medical errors or errors of commission or omission

14. School Health l Is school health a good thing? l Can you prove it is a good thing? l How do we make it part of the health care community (valued by stakeholders)? l Medication errors are likely to be rare! l Potential impact on quality may be high l Once part of the health care community it is subject to all of the same issues –Quality, efficiency, timeliness, equity, safety, patient-centeredness

15. Clinical Conditions to Consider l Diseases that are prevalent, require ongoing monitoring/therapy, high morbidity l Asthma – help make diagnosis, monitor disease, assist in use of medications correctly l Type 2 obesity – help with diagnosis and management, including medication l Type 1 obesity – help with management, including medication l Immunizations – maybe critically important l ADHD – has evolved because of qd dosing

16. Conclusion l School health is a huge enterprise l It is incumbent upon its advocates to show that it benefits students l Medication management is part of the quality revolution (effectiveness, timeliness)