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PEDIATRICS Vol. 113 No. 1 January 2004, pp. 185-198

SUPPLEMENT ARTICLE

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

Denise Dougherty, PhD and Lisa A. Simpson, MB, BCh, MPH, FAAP

From the Child Health Agency for Healthcare Research and Quality, Rockville, Maryland

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.

Key Words: quality of care • public opinion • effectiveness research

Abbreviations: AHRQ, Agency for Healthcare Research and Quality • SCHIP, State Children’s Health Insurance Program • CAHMI, Child and Adolescent Health Measurement Initiative • NICHQ, National Initiative for Children’s Health Care Quality • AAP, American Academy of Pediatrics • IOM, Institute of Medicine • NQF, National Quality Forum • QuIC, Quality Interagency Coordination • AMA, American Medical Association • CAHPS, Consumer Assessment of Health Plans Survey • ADHD, attention-deficit/hyperactivity disorder • ICU, intensive care unit • HEDIS, Health Plan Employer Data and Information Set • IT, information technology • NIH, National Institutes of Health • NHQR, National Healthcare Quality Report • NHDR, National Healthcare Disparities Report • CHCS, Center for Health Care Strategies • HRSA, Health Resources and Services Administration • NGC, National Guidelines Clearinghouse • CPD, continuous professional development • PBRN, primary care practice-based research network

Received for publication May 13, 2003; Accepted Oct 2, 2003.




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