PolicyLab

INTRODUCTION: With rising health care costs in the United States and other countries, there is a growing interest in measuring and improving the value of health care. In addition to programs such as the Choosing Wisely initiative, which identifies wasteful or unnecessary medical tests, pediatrics and perinatal medicine have seen the development of various measures of care quality. Most of these measures assess outpatient practices, such as immunization adequacy or the appropriate use of well care, in which all children are included regardless of their underlying medical complexity. For inpatient practice, however, the available metrics tend to focus on the care of more complex patients, such as the very low birth weight infant. Although this group of patients is important, given their high risk of adverse short- and long-term outcomes and their inherent high treatment costs, metrics focused on the very low birth weight infant (eg, reducing central line–associated bloodstream infections) may not provide insight into the quality of care received by the >85% of low-risk newborns born at term each year.,