perceived by parents as useful (Regaldo, Sareen, Inkelas, Wissow, and Halfon, 2004).
While improving the quality of health care for both adults and children is recognized as a national imperative, there has been relatively slow progress in developing quality of care measures for children’s health. The Institute of Medicine’s (IOM) report Crossing the Quality Chasm (Institute of Medicine, 2001a), adapting and modifying a model proposed by the Foundation for Accountability, suggested that the focus of services should be on staying healthy, getting better, living with illness, and coping with the end of life. While these represent appropriate foci for adult health services, they omit the important role of development in the context of children’s health. Moreover, coping with the end of life—an important issue for the small proportion of children who have life-threatening or terminal illnesses—is a relatively rare occurrence in childhood. The “staying healthy” rubric misses the importance of promoting optimal health and development. In addition, it is important to consider how health services delivered by both the personal medical care system and population health services perform and affect health outcomes in children. Crossing the Quality Chasm outlines several domains to measure the quality of services provided. These include medical services that are safe, effective, patient- and family-centered, timely, efficient, equitable, and coordinated.
The Foundation for Accountability, through its Child and Adolescent Health Measurement Initiative, has developed consumer surveys that can be administered to parents by health plans, Medicaid programs, and medical practices in order to assess the content and quality of the services that are being provided. The Young Adult Health Care Survey assesses perceptions of the content and quality of care for adolescents (Bethell, Klein, and Peck, 2001a); the Children with Special Health Care Needs Module for the Consumer Assessment of Health Plans Survey assesses the quality of services provided to children with chronic conditions (http://www.faact.org/faact/site/CAHMI/CAHMI/home?action=ViewGuidedTourSection&id=80); and the Promoting Healthy Development Survey assesses the content and quality of developmental services to children from birth to age 3 (Bethell, Peck, and Schor, 2001b; Bethell, Reuland, Halfon, and Schor, 2004). Although these mailed surveys provide information on quality as perceived by individual responding consumers, they are used primarily in populations already receiving health services in certain types of facilities rather than in the population in general. Thus, they systematically exclude the populations that are most deprived of needed services.
At present the major system that is used to measure the quality of personal health care provided by large health care organizations in the United States is the Health Employer Data Information System (HEDIS), operated by the National Committee on Quality Assurance (NCQA). HEDIS also assesses enrollees in health plans and contains very few indicators of the quality of children’s health care or measures of the quality of care they receive. For example, the only mea-