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The first phase of field trials have ended in the Child and Adolescent Health Measurement Initiative, and a complete set of performance indicators now moves a step closer to implementation.
The field trials focused on adolescent preventive care, early childhood development, and chronic care. Much of the measurement information was collected with a version of the pediatric CAHPS (Consumer Assessment of Health Plans Survey). (For more information on the initiative, see Patient Satisfaction & Outcomes Management, November 1998, p. 125.)
"We think patient and parent reports are the most reliable source of information about what happened in the context of well-child visits," says Christina Bethell, PhD, director of research for the Foundation for Accountability in Portland, OR, which is coordinating the initiative with the National Committee for Quality Assurance in Washington, DC.
"The adolescent is the best source of information about whether he or she received counseling about smoking or alcohol," she adds. "The medical record is not a very reliable source at all at this moment, and the claims data can only tell you they had a visit but not what happened."
Response rates overall for adolescent and parent surveys was about 50% in the field trials, but attaining a good response rate in inner-city and ethnically diverse areas was more challenging, the initiative coordinators found.
Performance measures that target care for chronic illnesses among children must be broad-based because of small sample sizes. For example, measures such as patients’ experience with care and provision of education, counseling, and support would combine data from children with different chronic conditions.
"Even large health plans don’t have enough children with diabetes or cerebral palsy [to create a large enough sample size for measurement]," says Bethell.
The RAND Corp. in Santa Monica, CA, is developing child health measures based on medical chart review, but that work is in early stages, Bethell says.