Established Child Health Care Quality Measures--Young Adult Health Care Survey (YAHCS)
Child Health Care Quality Toolbox
Contents
- Availability
- Child Measures Included
- Users
- Comparisons and Trends
- Benchmarking and Databases
- Service Delivery and Units of Analysis
- Length-of-Enrollment Requirements
- Data Issues
- Sample Sizes
- Resource and Burden Issues
- Development Process
- Criteria Used
- More Information and User Support
The Young Adult Health Care Survey (YAHCS) is a survey of adolescents 14-18 years of age that assesses how well the health care system provides adolescents with recommended preventive care. The YAHCS assesses the following aspects of care:
- The provision of private and confidential care.
- Preventive counseling and screening.
- Experience of care, helpfulness of care provided.
The YAHCS was developed under the Child and Adolescent Health Measurement Initiative (CAHMI). CAHMI was established in 1998 by the Foundation for Accountability (FACCT) and the National Committee for Quality Assurance (NCQA) with funding from The David and Lucille Packard Foundation, The Commonwealth Fund, the Federal Maternal and Child Health Bureau, Centers for Medicare & Medicaid Services, and AHRQ. The purpose of the CAHMI is to provide leadership and resources for measuring and communicating information about health care quality for children and adolescents. CAHMI is currently housed at Johns Hopkins University Bloomberg School of Public Health.
The YAHCS are available free of charge on CAHMI's Web site.
Online Resource: For more information on CAHMI, go to: http://www.cahmi.org
The YAHCS assesses the following aspects of preventive care:
- Preventive screening and counseling on risky behaviors.
- Preventive screening and counseling on sexual activity and sexually transmitted diseases (STDs).
- Preventive screening and counseling on weight, healthy diet, and exercise.
- Preventive screening and counseling on emotional health and relationship issues.
- Private and confidential care.
- Helpfulness of counseling.
- Communication and experience of care.
- Health information.
The YAHCS has been used to assess health care quality at the national, State, geographic, county, and health plan level. The following entities have used the YAHCS:
- Five health plans—CIGNA HealthCare (Southern California Branch), Blue Cross Blue Shield of the Rochester Area, Kaiser Permanente Medical Group, San Francisco Health Plan, and United Health Plan—and one professional review organization, the Institute for Child Health Policy, which used YAHCS as part of their Florida KidCare Evaluation efforts.
- Washington State Department of Health: to assess the quality of care provided to adolescents enrolled in Medicaid in Snohomish County.
- The FACCT Young Adult Online Survey about health and health care, funded by the Robert Wood Johnson Foundation, used components of the YAHCS.
- New York State Department of Health: to pilot the YAHCS for assessing quality of care in five selected health plans.
- Two projects within the Child Health Insurance Research Initiative (CHIRI™) used components of the YAHCS survey. For more information on CHIRI™, go to: https://archive.ahrq.gov/cpi/initiatives/chiri/.
The YAHCS results can be used for statistically significant comparisons among plans, programs, and health care providers. They can be used for trending over time, provided that the same or comparable populations are being surveyed and that the same mode of administration is used.
CAHMI has worked collaboratively with all users of the YAHCS and has maintained data related to these applications. However, currently no benchmarking data are publicly available that allow users to compare their findings with those of other users.
Service Delivery and Units of Analysis
YAHCS data can be collected and analyzed at the following levels of analysis:
- National.
- State.
- County or other geographic region.
- Health plan.
- By teen health, health care, and sociodemographic characteristics.
Results of the YAHCS can be used to report eight composite measures assessing domains of preventive and developmental health care recommended for young adults:
- Preventive screening and counseling on risky behaviors.
- Preventive screening and counseling on sexual activity and STDs.
- Preventive screening and counseling on weight, healthy diet, and exercise.
- Preventive screening and counseling on emotional health and relationship issues.
- Private and confidential care.
- Helpfulness of counseling.
- Communication and experience of care.
- Health information.
Length-of-Enrollment Requirements
The length-of-enrollment requirement depends on the purpose of the YAHCS implementation and the place of administration. Only young adults who are 14 years or older should receive the survey.
For health plan assessments, however:
- Medicaid managed care beneficiaries must be enrolled at least 6 months, with a break of no more than 30 days.
- Commercial (employer-based) plan members must be enrolled at least 12 months, with a break of no more than 45 days.
These rules generally apply for other assessment and tracking purposes.
The YAHCS can be administered by:
- Mail.
- Telephone.
- Internet.
The forthcoming Guidelines for Implementing the Young Adult Heath Care Survey will provide detailed information about how to plan a YAHCS project, administer the survey via mail or telephone, and score and report the survey findings to multiple stakeholders.
The Guidelines for Implementing the Young Adult Health Care Survey, available on the CAHMI Web site in July 2004, will provide detailed information about the sample sizes needed for specific applications of the YAHCS.
The production of performance measures is a data-driven activity. Credible survey data require close attention to proper sampling methods and adherence to survey administration protocols. These take time and money. Senior-level agency responsibility and sufficient staff resources are needed to ensure useful results.
The YAHCS was developed and tested through support from The Commonwealth Fund. It is one of three measurement sets recommended for use by the national advisory committee of the CAHMI.
A standard and rigorous six-stage process was used to develop the YAHCS. Focus groups were held with families and teens to identify the aspects of health care quality that are important to parents and teens in the area of preventive care. A review of the literature was conducted and relevant materials were considered, including seminal work by Jon Klein, M.D., and John Santelli, M.D., validating teen self-report about health care services received.
The six-stage development process included:
- Development of conceptual framework and investigation of relevance of measure.
- Development of a starting-point measurement proposal, including initial feasibility studies.
- Development of draft instrument and implementation methodology.
- Field testing (minimum of three sites).
- Revision and refinement of survey, survey administration protocol, and scoring protocol.
- Development of scientific and technical documentation and larger scale implementation and dissemination.
Three advisory groups within the CAHMI, comprised of pediatricians, family practitioners, consumer representatives, public health experts, and researchers, regularly reviewed and provided input on the identification of quality measurement topics and the development of the YAHCS.
The following criteria were used to select topics assessed in the YAHCS:
- Appropriateness for young adults 14-18 years and older.
- Strength of scientific evidence.
- Professional consensus.
- Lack of more reliable, valid, or efficient way to measure the topic.
- Importance of topic to young adults and parents as ascertained from cognitive interviews and focus groups.
- Ease with which the topic can be validly and reliably reported by parents.
- Parsimony (e.g., topic is not already largely represented by another, related topic in the YAHCS).
More Information and User Support
Online Resources:
More information about the development process and the initial pilot can be found on CAHMI's Web site and in "Assessing health system provision of adolescent preventive services: the Young Adult Health Care Survey," by Christina Bethell, Jonathan D. Klein, and Colleen Peck, published in Medical Care 2001 May;39(5):478-90.
Abstract available on PubMed®:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11317096&dopt=Abstract
For more information, contact CAHMI staff at info@cahmi.org or visit CAHMI's Web site. Go to: http://www.cahmi.org
