Established Child Health Care Quality Measures--Title V of the Social Security Act

Child Health Care Quality Toolbox

The Child Health Toolbox contains concepts, tips, and tools for evaluating the quality of health care for children.


National performance measures are part of annual reporting by State Title V Maternal and Child Health (MCH) Programs to the Maternal and Child Health Bureau (MCHB) of the Federal Health Resources and Services Administration (HRSA). MCHB works in collaboration with State agencies, the Association of Maternal and Child Health Programs, and others to periodically revise reporting guidance in response to legislative changes and program feedback. The third edition of the guidance requires annual reporting on:

  • Nine health systems capacity indicators.
  • Eighteen national performance measures.

In addition, MCHB publishes health status indicators and outcome measures for State Title V programs to use in their community needs assessments and development of 5-year planning strategies.

Online Resources:

For more information on the Maternal and Child Health Bureau, go to:

For more information on the Health Resources and Services Administration, go to:

For more information on the Association of Maternal and Child Health Programs, go to:

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Child Measures Included

Health System Capacity Indicators

Health system capacity indicators assess the strength of the MCH infrastructure in identifying and monitoring the needs of high priority clients. Four of the nine required health system capacity indicators relate to the quality of health care:

  • The rate of children hospitalized for asthma.
  • The percent of Medicaid enrollees under 1 year of age who received at least one initial periodic screen.
  • The percent of State Children's Health Insurance Program (SCHIP) enrollees under 1 year of age who received at least one periodic screen.
  • The percent of women with a live birth during the reporting year who had 80 percent or more of the expected prenatal visits.

National Performance Measures

MCHB categorizes the services provided through Title V MCH Block Grants in a pyramid of four types of services, as follows:

  1. At the pinnacle, Direct Health Care Services, that is, basic health services as well as health services for children with special health care needs (CSHCN).
  2. Next, Enabling Services, sometimes termed "wrap-around," focusing on access and other care-maximization services, such as transportation and outreach.
  3. Following that, Population-Based Services, that is, population-based preventive interventions, such as screening, counseling, and immunization.
  4. At the base of the pyramid, Infrastructure Building Services, such as:
    • Needs assessment.
    • Evaluation.
    • Planning.
    • Quality assurance.
    • Standards development.
    • Information systems.

The 18 national performance measures fit under the four categories represented by the pyramid.

Category: Direct Health Care.

  • Percent of newborns who are screened and confirmed with conditions mandated by their State-sponsored newborn screening program.
  • Percent of CSHCN whose families partner in decisionmaking and are satisfied with the services they receive.

Category: Enabling.

  • Percent of CSHCN in the State who have a "medical/health home."

 Category: Population-Based.

  • Percent of CSHCN whose families have adequate private and/or public insurance.
  • Percent of CSHCN whose families report the community-based service system can be used easily.
  • Percent of adolescents with special health care needs who received the services necessary to make transitions to adult life.
  • Percent of 19-35-month-olds who have completed immunizations for measles, mumps, rubella, polio, diphtheria, tetanus, pertussis, haemophilus influenza, and hepatitis B.
  • Rate of birth for teenagers aged 15 through 17 years.
  • Percent of third-grade children who have received protective sealants on at least one permanent molar tooth.
  • Rate of deaths to children aged 14 and under caused by motor vehicle crashes.

Category: Infrastructure Building.

  • Percent of mothers who breastfeed their infants at hospital discharge.
  • Percent of newborns who have been screened for hearing before hospital discharge.
  • Percent of children without health insurance.
  • Percent of potentially Medicaid-eligible children who have received a service paid for by the Medicaid program.
  • Percent of very low birth weight infants among all live births.
  • Rate of suicide among youths 15-19 years of age.
  • Percent of very low birth weight infants delivered at facilities for high- risk deliveries and neonates.
  • Percent of infants born to pregnant women who received care beginning in the first trimester.

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States use Title V health systems indicators and national performance measures as part of their ongoing programs for:

  • Monitoring.
  • Accountability.
  • Quality improvement.

State MCH programs submit their indicators as part of annual Title V block grant applications. Title V results are not used to determine block grant awards.

MCHB provides technical assistance to States to help them improve program performance and uses results of the national performance measures in its own performance improvement program under the Government Performance and Results Act of 1993 (GPRA).

Online Resource: For more information on the Government Performance and Results Act of 1993, go to:

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Comparisons and Trends

Title V national maternal and child health performance measures include broad rather than precise specifications. The measures were developed primarily for State use rather than for national comparisons.

States are charged with developing more precise specifications concerning:

  • Data elements.
  • Data collection.
  • Data analysis.

The goal of the Title V performance measurement set is to stimulate program development at the State level. However, under selected circumstances, Title V results could be used either for comparisons among States or to establish trend data for a State. For such comparisons to be valid within or among States, those States must, from year to year:

  • Use the same precisely defined terms.
  • Use the same procedures.
  • Use the same data elements.
  • Assess comparable population groups.

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Benchmarking and Databases

Online Resource: States vary in what and how they measure, so there is no single national database of measurement results. However, State-reported Title V maternal and child health data are available online. Go to:

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Service Delivery and Units of Analysis

The Title V measures are designed for use with statewide public health systems. Each State can customize the measures for use with particular service delivery systems if it so chooses.

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Length-of-Enrollment Requirements

Title V national maternal and child health performance measures do not include length-of-enrollment requirements. States are free to introduce minimum enrollment requirements into certain of their State-developed performance measures if they so choose.

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Data Issues

Title V maternal and child health measures identify recommended data sources but give States leeway. Data completeness and accuracy are critical issues with any performance measure. State users must address these issues to achieve results that will withstand scrutiny.

Specifications of the health system capacity indicators and the national performance measures include information on the calculation of each measure, source documents, and the significance of each measure to children.

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Resource and Burden Issues

The Title V maternal and child health performance measurement system uses an electronic reporting package (ERP) to minimize burden. The ERP:

  • Is a user-friendly database application.
  • Allows States to report data in a consistent format.
  • Generates printed forms and electronic data.
  • Automates calculation.
  • Updates multiple forms simultaneously.
  • Warns States when conflicting or unacceptable figures appear, thus enhancing the quality of the final data.
  • Includes standard word-processing templates for narrative portions of the application and annual report.

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Development Process

The process of developing Title V maternal and child health measures involves numerous components:

  • A work group including:
    • MCHB/HRSA staff.
    • Representatives of the Association of Maternal and Child Health Programs.
    • State MCH officials.
    • Researchers.
    • Other State health officials.
  • Broad-based solicitation of proposed measures (more than 400 received).
  • Intensive review of the proposed measures.
  • Development of criteria and categories.
  • Pilot use of the remaining measures by nine States.
  • Establishment of final list of 18 national performance measures and 9 health system capacity measures, along with health status indicators and outcomes measures.

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Criteria Used

The criteria included the following:

  • Measures should have relevance to State Title V activities.
  • Measures should be understandable to policymakers and the public.
  • Process and capacity measures should link to outcomes measures.
  • Necessary data should be generally available in the majority of States.

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More Information and User Support

Online Resource: More information is available on Title V national maternal and child health performance measures, MCHB/HRSA, and other aspects of the Title V national performance measures, outcome measures, and health status indicator sets. Go to:

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Page last reviewed November 2017
Page originally created September 2012
Internet Citation: Established Child Health Care Quality Measures--Title V of the Social Security Act. Content last reviewed November 2017. Agency for Healthcare Research and Quality, Rockville, MD.