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Measuring Quality of Children’s Health Care

Healthcare needs of children and adolescents are different from that of adults, and quality of care for children is inadequately minimal, because tools to measure children’s health care quality are scarce in numerous areas and many of the available measures are not being applied regularly. With the publication of reports from a Presidential commission, the Institute of Medicine, coalitions of health care purchasers, and foundations, a fresh impetus has been given to improve age specific quality of care for Americans. First ever initiative to address children’s health care quality measurement and improvement was begun in the U.S only in 1997 with the concerted efforts of federal and allied agencies that lead to the creation of Agency for Healthcare Research and Quality (AHRQ).

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The article by Dougherty & Simpson (2004, p.185-198) analyses the contents of three papers commissioned for presentation, and deliberations from the invitational meeting held under the patronage of AHRQ in February 2002. The presentations were followed by discussion among four groups of key participants, such as:

  1. the organizations like national committee on Quality Assurance and Joint Commission on Accreditations of Healthcare Organizations that developed measures;
  2. American Association of Pediatrics (AAP), the American Academy of Family Physicians, American Medical Association (AMA), and the Alliance of Community Health Plans as subjects and potential users of quality measure for accountability and/or improvement;
  3. users of quality measures; and
  4. experts in children’s health care, quality measures, or both.

Since these groups had developed individual sets of measures and offered diverse set of opinions and had overlapping interests Dougherty & Simpson (2004) declares that their text is not to reflect the precise views of participants. They first summarized and commented on the three commissioned articles and the recommendations made by the meeting participants for further action. Then they highlighted the areas in which progress is likely to emerge, and finally proposed many actions in which pediatricians can engage to contribute to continued improvements in the quality of children’s health care.

Among the three commissioned articles, first paper, presented by Beal et al, covered a broad literature search for quality measures for children’s health care and used the “IOM conceptual framework for quality to characterize the availability of measures” that employ ‘dual conceptualization’ of six “quality domains” and four “consumer perspectives.” (Dougherty & Simpson, 2004, p.185-198). Beal et al adopted institute of medicine (IOM) recommended additional criteria, after deconstructing the 19 identified child measurement sets, by using subscales corresponding to the IOM quality categories and in its absence placed individual items in appropriate categories for analysis. They found that over half of the categorized measures came under effectiveness domain, which is in line with ‘the national and international efforts to practice evidence-based health care.’ In addition, from the consumer/patient perspective 40% of the categorized measures were found to apply to the “getting better” or acute illness domain.

Second article by Kuhlthau et al related to children’s quality measures found that “adjusting or stratifying quality measures for risk has been an understudied area” even though “risk adjustment is relevant to measurement criteria of validity, feasibility, and equity and deserves a special focus” (ibid, 188). They observed that many quality measures exclusively relying on process may not require risk adjustments, pediatric ICU outcomes are well developed to support comparative studies of neonatal and pediatric ICU quality with few technical barriers, and quality measures should be stratified.

Third article, presented by Shaller, is based on semistructured interviews of opinion leaders from four of the groups represented in the meeting, covering six major topics for measuring the opinion leaders’ feed back in the use of quality measures. Though there was progress in the use of quality measures, the funders and developers of measures expressed ‘difficulty in generating sustained interest and support in child health quality-measurement development and implementing’ and suggested greater coordination among funders and developers.

The commissioned articles were discussed in depth in the meeting, select gap areas identified, and the highest scoring recommendations for national action to improve children’s health care quality were generated. The high ranking recommendations are:

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  1. create the requisite information technology (IT) infrastructure;
  2. build public support for quality measurement and improvement in children’s health care;
  3. improve reliability, validity, feasibility, and utility of existing measures for children’s health care; and
  4. conduct research to provide underlying scientific evidence (eg., of effectiveness and cost-effectiveness of services).

The committee also articulated the dearth of resources, particularly barriers to the widespread implementation of IT across the spectrum of patients and health care settings, to help measurement developers improve existing measures. All the participants spoke in unison for the development of quality measures and the implementation of quality-improvement strategies for children’s health care, because rate of return on investment made in children’s health care will be more productive.


Dougherty, Denise., & Simpson, Lisa.A. (2004). Measuring the quality of children’s health care: A prerequisite to action. Pediatrics: Official Journal of the American Academy of Pediatrics, 113 (1), 185-198. Web.

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