Children’s Health Care: Quality And Access Issues

2004 ◽  
Vol 23 (5) ◽  
pp. 76-76
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Care Quality ◽  
Children's Health ◽  
Children’S Health ◽  
Children’S Health Care

Implementing and Using Quality Measures for Children’s Health Care: Perspectives on the State of the Practice

PEDIATRICS ◽  
2004 ◽  
Vol 113 (Supplement_1) ◽  
pp. 217-227 ◽  
Author(s):  
Dale Shaller
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care Quality ◽  
Quality Measurement ◽  
Quality Measures ◽  
Care Quality ◽  
Children's Health ◽  
Children’S Health ◽  
Health Plans ◽  
Children’S Health Care

Objective. The objective of this study was to identify issues, obstacles, and priorities related to implementing and using child health care quality measures from the perspectives of 4 groups: 1) funders of quality-measurement development and implementation; 2) developers of quality measures; 3) users of quality measures (including Medicaid and the State Children’s Health Insurance Program, employer coalitions, and consumer groups); and 4) health plans and providers (in their role as both subjects and users of quality measures). Methods. A series of semistructured interviews was conducted with ∼40 opinion leaders drawn from these 4 groups. The interviews were conducted by telephone between September and December of 2001. Major topic areas covered in the interviews were similar across the groups. Topic areas included 1) strategic vision and/or objectives for funding, developing, or using quality measures for children’s health care; 2) a brief summary of the specific quality measures funded, developed, or used; 3) issues and challenges facing funders and developers of measures; 4) major successes achieved; 5) obstacles to implementation and use of measures; and 6) priority needs for future funding. Results. Leaders from all 4 groups acknowledge the importance of developing a robust set of quality measures that can serve multiple objectives and multiple audiences. Standardization of measures is viewed as a critical feature related to all objectives. An assessment of specific quality measures funded, developed, or used by strategic objective shows a high correlation between the uses intended by funders and developers and the actual applications of the various users. The most commonly cited measures across all groups are the Consumer Assessment of Health Plans Survey and Health Plan Employer Data and Information Set, followed by the Child and Adolescent Health Measurement Initiative and special topic studies to support quality-improvement applications (eg, asthma, diabetes, etc). The major issues and challenges cited in common among funders and developers are 1) the lack of trained capacity in the field to conduct needed research and development, and 2) the difficulty in generating sustained interest and support among funders because of the complexity of quality-measurement issues, competing funding priorities in the face of limited funds available to allocate, and the lack of clear and compelling evidence that quality measurement and improvement actually result in better outcomes for children. The 3 most common successes cited across all 4 groups are 1) the growing consensus and collaboration among diverse stakeholder groups involved in measurement development and implementation; 2) the increasing collection and use of specific measures; and 3) early documentation of tangible results in terms of improved quality of care. Specific measurement tools cited as successes by funders and developers include the Medicaid Health Plan Employer Data and Information Set, Consumer Assessment of Health Plans Survey, the Child and Adolescent Health Measurement Initiative, and Rand QA Tools. The most important obstacle reported across all groups is the lack of a strong and compelling “business case” that clearly demonstrates the benefits of quality measurement relative to the costs of implementation. Strongly related to this barrier is the cost of implementing and using measures without a sustainable source of financing as well as the absence of strong public awareness and political support for children’s health care quality measurement. Another major barrier cited is the lack of coordination among funders, which prevents the field from developing a unified approach to addressing the numerous technical, political, and administrative issues also cited at length by the leaders interviewed. The 5 top needs for future funding identified across all 4 groups follow directly from the major obstacles that they reported: 1) develop the business case for children’s health care quality measurement and improvement based on rigorous cost-benefit analysis and documentation of quantifiable successes; 2) develop new measures to fill the gaps in critical areas (including adolescent health care, behavioral health, and chronic conditions) that can be applied at the hospital and ambulatory care provider levels; 3) invest in building needed research capacity, a trained pool of users of quality measures, and the capacity among providers to understand and use quality-improvement methods and tools; 4) invest in developing an information infrastructure that will support the efficient collection and use of measures for multiple purposes, including clinical practice, quality measurement, and quality improvement; and 5) develop increased public awareness and support for quality measurement based on improved strategies for communicating with consumers, purchasers, providers, and policy makers. Conclusions. Several implications are suggested by these perspectives for the future direction of quality measurement in children’s health care. First, to meet the funding needs identified, many funders must improve coordination to reduce the noise and fragmentation generated by numerous competing or redundant activities. Improved coordination among funders will help assure maximum impact and the efficient use of scarce resources. Second, the importance attached to standardization of measures by both users and developers may conflict at times with the need for innovation and flexibility. Child health quality leaders will need to manage this tension between standardization and innovation to maintain an appropriate balance between the benefits of both. Finally, many of the obstacles identified are not unique to children’s health care. Child health quality leaders will need to determine to what extent their efforts to overcome these obstacles can be successfully undertaken independently as opposed to in concert with groups concerned about other populations and sectors in the health care system.

What Factors Influence States’ Capacity to Report Children’s Health Care Quality Measures? A Multiple-Case Study

2016 ◽  
Vol 21 (1) ◽  
pp. 187-198
Author(s):  
Anna L. Christensen ◽  
Dana M. Petersen ◽  
Rachel A. Burton ◽  
Vanessa C. Forsberg ◽  
Kelly J. Devers
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Multiple Case Study ◽  
Quality Measures ◽  
Care Quality ◽  
Children's Health ◽  
Children’S Health ◽  
Multiple Case ◽  
Children’S Health Care

scholarly journals After The Demonstration: What States Sustained After the End of Federal Grants to Improve Children’s Health Care Quality

2017 ◽  
Vol 22 (2) ◽  
pp. 195-203 ◽  
Author(s):  
Henry T. Ireys ◽  
Cindy Brach ◽  
Grace Anglin ◽  
Kelly J. Devers ◽  
Rachel Burton
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Care Quality ◽  
Children's Health ◽  
Children’S Health ◽  
Federal Grants ◽  
Children’S Health Care

Quality Measures for Children’s Health Care

PEDIATRICS ◽  
2004 ◽  
Vol 113 (Supplement_1) ◽  
pp. 199-209 ◽  
Author(s):  
Anne C. Beal ◽  
John Patrick T. Co ◽  
Denise Dougherty ◽  
Tanisha Jorsling ◽  
Jeanelle Kam ◽  
...  
Keyword(s):  
Health Care ◽  
Child Health ◽  
End Of Life ◽  
Health Care Quality ◽  
Quality Measures ◽  
Care Quality ◽  
Children's Health ◽  
Children’S Health ◽  
Care Needs ◽  
Children’S Health Care

Background. The ability to measure and improve the quality of children’s health care is of national importance. Despite the existence of numerous health care quality measures, the collective ability of measures to assess children’s health care quality is unclear. A review of existing health care quality measures for children is timely for both assessing the current state of quality measures for children and identifying areas requiring additional research and development. Objectives. To identify and collect current health care quality measures for child health and then to systematically categorize and classify measures and identify gaps in child health care quality measures requiring additional development. Design/Methods. We first identified child health care quality instruments with assistance from staff at the Agency for Healthcare Research and Quality, experts in the field, the Computerized Needs-oriented Quality Measurement Evaluation System, the Child and Adolescent Health Measurement Initiative, and a medical literature review. From these instruments, we then selected clinical performance measures applicable to children (aged 0–18 years). We categorized the individual measures into the Institute of Medicine’s framework for the National Health Care Quality Report. The framework includes health care quality domains (patient safety, effectiveness, patient-centeredness, and timeliness) and patient-perspective domains (staying healthy, getting better, living with illness, and end-of-life care). We then determined the balance of the measures (how well they assess care for all children versus children with special health care needs) and their comprehensiveness (how well the measures apply to the developmental range of children). Finally, we analyzed the ability of the measures to assess equity in care. Results. We identified 19 measure sets, and 396 individual measures were used to assess children’s health care quality. The distribution of measures in the health care quality domains was: safety, 14.4%; effectiveness, 59.1%; patient-centeredness, 32.1%; and timeliness, 33.3%. The distribution of measures in the patient-perspective domains was: staying healthy, 24%; getting better, 40.2%; living with illness, 17.4%; end of life, 0%; and multidimensional, 23.5% (measures were multidimensional if they applied to >1 domain). Most of the measures were meant for use in the general pediatric population (81.1%), with a significant proportion designed for children with special health care needs (18.9%). The majority (≥79%) of the measures could be applied to children across all age groups. However, there were relatively few measures designed specifically for each developmental stage. Regarding the use of measures to study equity in health care, 6 of the measure sets have been used in previous studies of equity. All the survey measure sets contain items that identify patients at risk for poor outcomes, and 4 are available in languages other than English. However, only 1 survey (Consumer Assessment of Health Plans) has undergone studies of cross-cultural validation. Among the measure sets based on administrative data, 3 included infant mortality, a well-known measure of health disparity. Conclusions. There are several instruments designed to measure health care quality for children. Despite this, we found relatively few measures for assessing patient safety and living with illness and none for end-of-life care. Few measures are designed for specific age categories among children. Although equity is an overarching concern in health care quality, the application of current measures to assess disparities has been limited. These areas need additional research and development for a more complete assessment of health care quality for children.

Measuring the Quality of Children’s Health Care: A Prerequisite to Action

PEDIATRICS ◽  
2004 ◽  
Vol 113 (Supplement_1) ◽  
pp. 185-198 ◽  
Author(s):  
Denise Dougherty ◽  
Lisa A. Simpson
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Care Quality ◽  
Quality Measurement ◽  
Quality Measures ◽  
Care Quality ◽  
Children's Health ◽  
Children’S Health ◽  
Children’S Health Care

Objective. To assess the availability and use of quality measures for children’s health care, highlight promising developments, and develop recommendations for future action steps by the child health quality measurement and improvement fields, pediatrics, and the national quality of care enterprise generally. Study Design. Two-day invitational expert meeting, informed by 3 commissioned articles. Results. Quality of care for children is far less than optimal. A number of measures are available for measuring children’s health care quality on a regular basis, although measures are scarce at least in many areas (eg, pediatric patient safety, end-of-life-care, mental health care, oral health care, neonatal care, care for school-aged children, and coordination of care). Many of the available measures are not being applied regularly to measure the quality of children’s health care; barriers to implementation include lack of an information infrastructure that is child- and quality-friendly and lack of public support for improving children’s health care quality. To improve the availability and use of quality measures for accountability and improvement, meeting participants recommended that at least 4 activities be national priorities: 1) build public support for quality measurement and improvement in children’s health care; 2) create the information technology infrastructure that can facilitate collection and use of data; 3) improve the reliability, validity, and feasibility of existing measures; and 4) create the evidence base for measures development and quality improvement. Conclusions. Although substantial progress has been made in the development of quality measures and the implementation of quality-improvement strategies for children’s health care, interest in quality of care for children lags behind that for adult conditions and disorders. Making significant progress will require not only sustained attention by those concerned about improving children’s health and health care but also activities to build a broad base of support among the public and key health care decision-makers.

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