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Assessing managed care for children with chronic conditions
K Kuhlthau1, D K Walker, J M Perrin
1General Pediatrics Research Unit, Massachusetts General Hospital, Boston, USA.
Health Affairs (Project Hope)
|August 6, 1998
Summary
This study evaluates the Health Plan Employer Data and Information Set (HEDIS) for monitoring chronically ill children. It proposes improvements to HEDIS to better assess and report on the care these children receive.
Area of Science:
- Healthcare Quality
- Pediatric Health
- Managed Care
Background:
- Children and adolescents with chronic conditions require specialized healthcare monitoring.
- Current quality metrics may not adequately assess the managed care received by these vulnerable populations.
Purpose of the Study:
- To review opportunities for monitoring managed care for pediatric chronic conditions.
- To assess the suitability of the Health Plan Employer Data and Information Set (HEDIS) for this population.
- To propose enhancements to HEDIS to improve its applicability.
Main Methods:
- Review of existing literature and quality monitoring frameworks.
- Analysis of the Health Plan Employer Data and Information Set (HEDIS) 3.0 capabilities.
- Formulation of recommendations for HEDIS improvement.
Main Results:
- HEDIS 3.0 has limitations in assessing care for children with chronic conditions.
- Specific methods are needed to identify and monitor these children.
- Separate reporting and tailored indicators are essential for effective evaluation.
Conclusions:
- HEDIS requires significant adaptation to effectively monitor managed care for children with chronic conditions.
- Four key steps are proposed: improved identification, separate reporting, tailored surveys, and specific indicators.
- These enhancements will lead to better quality assessment and care for pediatric chronic conditions.