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Quality measures for children's health care
Anne C Beal1, John Patrick T Co, Denise Dougherty
1Center for Child and Adolescent Health Policy, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA. acb@cmwf.org
Pediatrics
|January 2, 2004
Summary
Current child health care quality measures are insufficient, with gaps in patient safety, chronic illness care, and end-of-life assessments. Further development is needed to fully evaluate pediatric health care quality and equity.
Area of Science:
- Pediatric Health Services Research
- Health Care Quality Measurement
Background:
- Assessing and enhancing children's healthcare quality is a national priority.
- Existing quality measures may not comprehensively cover pediatric needs.
- A review is crucial to understand current pediatric quality measurement and identify gaps.
Purpose of the Study:
- To identify, collect, and categorize existing healthcare quality measures for children.
- To classify these measures using the Institute of Medicine's framework.
- To identify gaps in pediatric quality measures requiring further development.
Main Methods:
- Systematic review of child health care quality instruments and literature.
- Selection of clinical performance measures for children aged 0-18 years.
- Categorization using the Institute of Medicine's quality domains and patient-perspective domains.
- Analysis of measure balance, comprehensiveness, and equity assessment capabilities.
Main Results:
- 19 measure sets and 396 individual measures were identified.
- Measures were distributed across quality domains (effectiveness: 59.1%, patient-centeredness: 32.1%, timeliness: 33.3%, safety: 14.4%) and patient perspectives (getting better: 40.2%, staying healthy: 24%, living with illness: 17.4%, end-of-life: 0%).
- Most measures applied to the general pediatric population (81.1%) and across age groups, but few were age-specific. Limited application for assessing health care equity was noted.
Conclusions:
- Existing instruments offer some assessment of pediatric healthcare quality.
- Significant gaps exist in measures for patient safety, chronic illness management, and end-of-life care.
- Development is needed to improve age-specific measures and the assessment of health care equity for children.