From Local to National Impact: Pediatric Vital Signs

When Nationwide Children’s Hospital first announced its Pediatric Vital Signs project in 2018, no health care institution had done anything quite like it before. The hospital and its partners wanted to collaboratively improve the overall well-being of children across the population of Franklin County, Ohio, using anchor metrics like infant mortality, suicide, and high school graduation rates.

These were population-level “vital signs,” the way blood pressure and temperature are individual vital signs. If a population’s health could be measured, then population-level interventions could be made to improve that health.

Now, a new, related set of national “Pediatric Vital Signs” has been proposed through the National Academy of Medicine that could be used by hospitals and regions across the United States. Kelly Kelleher, MD, MPH, vice president of Community Health at Nationwide Children’s, is a founder of the hospital’s project and chaired the National Academy of Medicine committee behind the recently proposed national Pediatric Vital Signs.

He is co-author of a set of four papers laying out the national metrics.

“No matter how wonderful the care inside its walls, a health care system is not a great one if the children and families in the community are sick,” said Dr. Kelleher. “Health care institutions should have a responsibility not just to take care of the patients who come in their doors, but they should have a responsibility for everyone’s health. These Vital Signs are a step in allowing that to happen.”

In fact, the Nationwide Children’s Pediatric Vital Signs project was inspired by an earlier project from the National Academy of Medicine, which had proposed a set of metrics to measure adult well-being. The Nationwide Children’s project, and the National Academy of Medicine’s new metrics, were a result of those.

For pediatric vital signs to work at a local or national level, they must represent the entire course of childhood, and they must be based on accurate, available data, says Kelleher. There are eight Franklin County Pediatric Vital Signs because reliable data can be gathered for them: infant mortality, kindergarten readiness, high school graduation, obesity, teen pregnancy, suicide and two composite measures for all-child mortality and preventive care.

There are four proposed national Pediatric Vital Signs:

• Infant mortality. It is one of the most well-accepted public and population health metrics, and data for it is widely available by geographic area.
• School readiness. This measure includes “academic” readiness for kindergarten, like numeracy and literacy, but also information relating to social, emotional and physical development. Many states collect versions of this data, but it isn’t standardized.
• Chronic absenteeism in middle school. This metric focuses on children in early adolescence, and it can provide a window into other overall well-being issues, like health and poverty.
• High school graduation. Graduation rates can help measure a population’s current readiness, and they are a predictor of future success.

As Nationwide Children’s continues to collect data for its own Pediatric Vital Signs and pursue interventions to improve outcomes, the national vital signs can provide a more general framework for others.

“While no one has gone as broadly as Nationwide Children’s, there are other hospitals who are interested in this work for themselves,” Dr. Kelleher said. “These new papers give them a structure to start.”