TABLE 3.

Selected Gap Areas, Promising Developments, and Remaining Challenges

Gap AreaSelected Promising Development(s)Example of Remaining Challenges
Research needed to provide underlying scientific evidence of effectiveness and efficiency of health care services• Commonwealth Fund commitment to Healthy Steps101103Relative to biomedical research, few resources are available to conduct research on effectiveness and efficiency of services in real-world settings
• Findings from AHRQ-supported research on specific clinical interventions,104 comparative effectiveness of different management approachs,105 factors associated with better outcomes,106 and cost-effectiveness of treatment strategies107
• Pediatric patient safety research agenda75,108,109
• Proposed National Children’s Study50
Reliability, validity, feasibility, and utility of existing measures for children’s health care quality• Beal et al’s compilation of articles on selected measures and measurement sets• Paucity of attention to children’s measures as efforts to make quality measures more scientifically sound progress
• Recent development of criteria for assessing these aspects of measurement18,22,84,110
• Paucity of resources for funding further testing of existing measures
• IOM Committee’s call for development of reliable and valid measures for use across public programs60
Development of new quality measures• Addition of CAHPS, asthma, and preventive services measures to Medical Expenditure Panel Survey47Inadequate number of valid, reliable, and feasible measures for critical areas of children’s health care:
• New AHRQ quality indicators for prevention, inpatient care, and patient safety including children’s measures111• Oral/dental health115,116
• Mental health117
• Children’s well-being and optimal development
• CAHPS-like mental health measure, Experience of Care and Health Outcomes Survey• Coordination of care, particularly for children with special health care needs19,119,120
• Compendium of mental health measures will include some for children112,113• Domains of equity121 and efficiency
• Important clinical conditions and settings of care
• Dental measures developed by Bader et al114
• Quality-improvement purposes
• Promoting Healthy Development Survey
• Development of pediatric group-level CAHPS measure by CAHPS II collaborators91
Public support• NHQR122 and NHDR54,56• Public concepts about children’s needs do not seem to include health care or its quality126
• Making the Case for Children’s Healthcare Quality
• QuIC Task Force17• Poll-takers do not ask the public about children’s health care quality15,127
• Patient Safety Task Force123
• CHCS efforts124• Frameworks for thinking about quality have not been developed with relevance to children110
• CAHMI State Learning Network125
• IOM reports: Leadership by Example60 and Priority Areas62
• Resurgence of health care costs as a focus may undermine the focus on quality