Measurement Strategies

Example Measures

Providers are using appropriate screening/ surveillance measures to detect problems

Rates of children receiving indicated assessments with appropriate instruments

Estimating costs of interventions

Average expenditure per child identified

Parents report services are available and they can have problem assessed

Rates of children actually reaching indicated services

Rates of services based on American Academy of Pediatrics guidelines

Proportion of children appropriately identified

1. Routine periodic survey of provider about knowledge, skill, and tracking needs

1. Self-assessment of skill to conduct appropriate risk assessment

2. Community health service—asset mapping of developmental services in community

2. Adequate referral services

Monitoring of avoidance of unsafe or unwarranted interventions

Rates of initiation of inappropriate modes of therapy

Same provider/practice conducting assessment

Rates of children with regular person conducting assessment

Assess parent satisfaction with assessment and its results

Satisfaction with care by ethnicity, income, and practice type

Spectrum of care provided without conflict in management strategies (e.g., drug

Rates of conflicting advice or incompatible advice and/or management incompatibilities)

Population-based monitoring of all aspects of health system performance

No differences in access to or receipt of individual services

Quality have unexplored potential for assessing the effects of policy changes on children’s health outcomes. For example, state trends in health insurance coverage using the Census Bureau’s CPS could be expanded to assess the effect of Medicaid or SCHIP policy changes on enrollment. Available national surveys such as the NHIS and the Medical Expenditure Panel Surveys could potentially provide insight into effects on access and utilization. They do not provide the state-level estimates necessary to monitor such programs as Medicaid and SCHIP, which are under state jurisdiction. National data systems provide very few data to assess whether policy changes designed to affect enrollment, access, or utilization of health care services actually result in changes in children’s health outcomes. The best attempts that have been made to examine the effect of changes in Medicaid on children’s health have been done using very long time frames and very gross and narrow measures of health outcomes, such as infant mortality (Currie and Gruber, 1996b).

Many health and other social policies are focused on reducing disparities in

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