Child and Adolescent Health and Health Care Quality Measuring What Matters (2011) / Chapter Skim
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Conceptually sound and reliable health and health care measures for children and adolescents can be used to assess the effects of disease or injury on health; identify vulnerable children in clinical settings and vulnerable population subgroups in health plans or geographic regions; measure the effects of medical care, policy, and social programs; set targets for improving health care; and improve health outcomes. Despite the presence of multiple data sets and measures, however, the United States currently has no robust national information system that can provide timely, comprehensive, and valid and reliable indicators of health and health care quality for children and adolescents.
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make recommendations for improving and strengthening the timeliness, quality, public transparency, and accessibility of information on child health and health care quality. CONCLUSIONS The committee reviewed multiple federal sources of data on the health and health care quality of children and adolescents, 24 core measures of health care quality recommended by the Secretary of HHS in 2010 for voluntary reporting by Medicaid and CHIP programs, and a number of private-sector efforts aimed at developing valid and reliable measures of health and health care quality for children and adolescents, as well as the salient research literature.
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on the health status of children and adolescents and their use of health care services. Earlier IOM/NRC reports have documented the extent to which such information is lacking in existing federal health and health care data sets, and stressed that these contextual factors are key influences on the short- and long-term health outcomes of children and adolescents.
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• W ith respect to social determinants of health, data are needed to determine those elements that offer timely potential for prediction of disparities. • R ace/ethnicity, socioeconomic status, primary language spoken at home, and parental English proficiency all affect disparities in health and health care and therefore are relevant topics for data collection for all children and adolescents.
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• L inking or aggregating databases offers opportunities to reduce variations among multiple data sources and to decrease the burden of data collection on individual states, providers, health plans, and households. • W hile it is often difficult to connect data from the clinical records of children and adolescents enrolled in public health insurance plans to population health surveys and administrative data sets, such efforts will increase understanding of the social context and life-course influences that may affect children's health status and their access to and use and quality of health care services.
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Some of these strategies represent actions that can be taken now; others require a longer-term effort. They are aimed at aligning the areas of measurement of the health of children and adolescents that are emerging in population health surveys and longitudinal studies -- areas that go beyond health conditions to assess health functioning, health potential, and health influences -- with existing efforts to measure health care quality for children and adolescents.
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Yet important initiatives have emerged within population health surveys, longitudinal studies, and other research studies that provide data sources and opportunities to develop new measures in the remaining five areas. These initiatives warrant increased support because of their capacity to inform the next generation of health care quality measures, especially in areas that involve disparities, social determinants of health, and the life course, as well as the emerging health information technology (HIT)
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Step 2: Develop Annual Reports and Standardized Measures Based on Existing Data Sets Efforts to monitor and improve the health of children and adolescents are hampered by both the lack of annual reports that focus on child and adolescent health and health care quality and the absence of standardized measures and variation in salient data sources. Of particular concern are the lack of consistent measurement of disparities in health and health care quality to support the development of targeted interventions at the national and state levels and the retention of unnecessary or obsolete measures resulting from the adoption of nonstandardized core measure sets.
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A Periodic Review Process The purpose of a periodic review of health and health care quality measures is to ensure that the system for child and adolescent health and health care quality measurement is achieving its information goals (public transparency, timeliness, accessibility, and quality) ; to identify obsolete, unnecessary, or redundant measures; to highlight emerging candidates for new measures; and to identify areas that deserve consideration in the development of valid and reliable measures in keeping with new health goals for children and adolescents.
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Step 3: Create New Measures and Data Sources in Priority Areas Ideally, child and adolescent health and health care quality measures and data sources should support analyses that can demonstrate how changes in funding levels for public insurance programs (such as Medicaid or CHIP) or in eligibility requirements, enrollment levels, or service procedures affect health outcomes, health care costs, and school achievement.
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Creating opportunities to link data across multiple health care settings, as well as connecting health and health care data to education and human service data systems, would improve timeliness and facilitate analysis of the
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While it may not be feasible to introduce longitudinal approaches into health care quality measures, longitudinal studies can identify specific data elements that merit consideration in the creation of new quality measures. Finally, timely and transparent data systems can help engage parents in data collection efforts through explanation of the purpose of the effort and how the data will be used to assist their own and other children and adolescents throughout the country.
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Some states are prepared to serve as laboratories for the creation of new measures for difficult-to-measure indicators or difficultto-reach populations, and they would benefit from the development of incentives that encourage voluntary compliance in these areas. The emerging HIT infrastructure offers an opportunity to emphasize the distinct needs of children and adolescents and to link those needs to family data in health information exchanges, as well as to supplement traditional electronic heath information with data from other sources (including parents)
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Much can be done with existing efforts, supplemented by modest additional resources, to go beyond traditional boundaries to incorporate data elements that can deepen our understanding of the complex interactions among health, health care quality, and the social determinants of health. Innovations in technology and data gathering methods enhance the potential to develop new measures that can inform our understanding of important health disparities, preventable health conditions, and the social determinants of health and enable a life-course approach to the assessment of health and health care quality for our nation's youth.
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