Why Child Health Measures?
Child Health Care Quality Toolbox
In recent years, there has been growing interest in a special focus on quality measurement for child health programs. Increasingly, it has become clear that the issues for children are not identical to those for adults.
Child health has unique characteristics that differentiate it from adult health. These characteristics must be reflected in:
- Child health care delivery systems.
- Child health care services.
- Use of quality measurement to assess child health performance.
The unique characteristics of child health, often referred to as the "four D's," are:
Developmental Status and Change
As a matter of healthy normal growth, children pass rapidly through many developmental stages of cognitive, emotional, and physical growth. Successful completion of each stage is important to health in the next. Measurement approaches must be appropriate to each stage.
Example: Although adolescents are reliable sources of information for surveys on some types of health care, parents or guardians must be surveyed when assessing health care for the very young.
Children experience a unique pattern of health, illness, and disability. Children's basic physiology differs from that of adults in many ways.
- Children's ear canals are shorter than those of adults, making them more susceptible to ear infections and otitis media.
- Failure to adjust drug dosages for the lower weights of children can have adverse consequences.
Children have fewer chronic physical ailments than adults, making it harder to reliably measure performance related to the care of chronic conditions among children. There is a growing literature documenting quality-of-care problems specific to children.
Children's health care is dependent on adults in several ways.
Access. Children depend on adults for access to health care. Adults decide when children need care and take them to obtain care or provide it for them.
Consistency. Whether children receive needed services in a timely fashion or follow through on recommended treatments typically depends on adult caregivers.
Continuity. Adults receive most health care in a doctor's office or other dedicated health care setting. Children may receive health care in a more fragmented fashion:
- At day care.
- In school.
- In community centers.
- In doctor's offices or clinics.
- At other locations.
These factors increase the importance of provider communication skills, as well as the significance of the provider's role in securing appropriate child health services.
Dependence on adults and the fragmentation of service delivery systems pose problems related to:
- Coordinating care.
- Ensuring complete preventive services.
- Gathering data to assess the delivery of child health services.
Additionally, the modeling influence of adults has a powerful impact on child health. Whether children develop behaviors conducive to good or bad health is dependent on factors such as:
- Eating habits.
- Exercise habits.
- Exposure to secondhand smoke.
- Exposure to violence.
Family behaviors have a major impact on all of these.
In the United States, the high rates of children living in poverty and in single-parent families shape both children's health and children's health care. Further, children are the most culturally and ethnically diverse segment of our society. The particular perspectives and problems of accessing and coordinating children's health care in a variety of settings must be factored into decisions concerning child health services delivery and its assessment.
Children with Chronic Health Conditions
A priority for child health programs is to assure that children with chronic health conditions, sometimes referred to as "children with special health care needs," receive quality health services. Development of measures has been lengthy because small numbers of children experience any single chronic or other special health care condition. New components have been added to the Expanded CAHPS® Child Survey to assess the services provided to such children and their families.
Online Resource: For more information on children with chronic health conditions, go to: http://www.ahrq.gov/chtoolbx/measure2.htm#cahpsChronicConditions
Want More Information?
Dougherty D, Simpson LA. Measuring the quality of children's health care: a prerequisite to action. Pediatrics 2004 Jan;113(1 Pt 2):185-98.
Abstract available on PubMed®: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14702501&dopt=Abstract
Forrest CB, Simpson L, Clancy C. Child health services research: challenges and opportunities. JAMA 1997 Jun 11;277(22):1787-93.
Abstract available on PubMed®: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9178792&dopt=Abstract.
Keren R, Pati S, Feudtner C. The generation gap: differences between children and adults pertinent to economic evaluations of health interventions. Pharmacoeconomics 2004;22(2):71-81.
Abstract available on PubMed®: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14731049.