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Measuring health outcome in paediatrics: development of the RAHC measure of function
D R Dossetor1, J L Liddle, C M Mellis
1Royal Alexandra Hospital for Children, Parramatta, New South Wales, Australia.
Insights
The RAHC Measure of Function (MOF) is a new tool for assessing paediatric health outcomes. It is easy to use, understandable for parents, and shows moderate reliability and responsiveness to change.
Area of Science:
- Paediatric Health Services Research
- Health Outcome Measurement
- Clinical Assessment Tools
Background:
- Developing reliable and valid measures of health outcome is crucial for evaluating paediatric health services.
- Existing measures may not adequately capture functional health status in children or be easily understood by parents.
Purpose of the Study:
- To develop and validate the RAHC Measure of Function (MOF), a genetic measure of health outcome for paediatric health services.
- To assess the utility, reliability, and responsiveness of the MOF.
Main Methods:
- The MOF was adapted from the Child Global Assessment Scale.
- Inter-clinician agreement was assessed using case scenarios and outpatient data.
- Parent-clinician agreement was evaluated in outpatient settings.
- Responsiveness to change was measured in paediatric inpatients.
Main Results:
- Inter-clinician agreement for case scenarios showed moderate reliability (kappa = 0.42).
- High agreement rates were observed between clinicians and between parents and clinicians in specific clinics.
- The MOF demonstrated significant improvement in scores from admission to discharge in inpatient children (median increase from 50.5 to 79).
Conclusions:
- The MOF is a user-friendly tool that provides a valuable and understandable description of paediatric health outcomes.
- The MOF exhibits moderate reliability, suitable for comparing groups of paediatric patients.
- The MOF is responsive to clinical changes, indicating its utility in tracking patient progress.
Objective:
To develop a genetic measure of health outcome (the RAHC Measure of Function) for paediatric health services.
Methodology:
The RAHC Measure of Function (MOF) was modified from the Child Global Assessment Scale. The utility and reliability of the MOF was then tested by inter-clinician agreement on case scenarios, by inter-clinician agreement in outpatients, by parent-clinician agreement in outpatients and by responsiveness to change in acute admissions.
Results:
The inter-clinician agreement on MOF ratings for case scenarios was moderately good, with an overall kappa of 0.42; P < 0.0001. Clinicians at respiratory and child psychiatry clinics nominated the same or adjacent MOF category to describe 100% (95% CI: 71.5-100) and 90% (95% CI: 68.3-98.8%) of 11 and 20 cases assessed, respectively. Parents nominated the same or adjacent MOF category as the attending clinician for 89.7% (95% CI: 72.7-97.8) and 82.9% (95% CI: 67.9-92.9) of 29 and 41 children in the same two clinics. Twenty-eight inpatient children had an MOF assessed on admission and discharge, and the median MOF score improved from 50.5 to 79 points (z = 4.53; P < 0.0001).
Conclusions:
The MOF is easy to use and provides a valuable description of health outcome that parents are able to understand. The MOF is moderately reliable, is likely to be sufficiently reliable to compare groups of paediatric patients and is responsive to change.