• important areas of health (mental health, oral health, and inpatient care) and care processes (particularly care coordination across multiple settings).

  • The effectiveness of preventive services is particularly difficult to measure because the outcomes may not be known for many years, and the impact may vary according to the risk profile of the patient population. Current preventive measures are largely process focused, and do not consider the outcomes of screening efforts or whether recommended treatment services were actually provided in an effective, evidence-based, equitable, family-centered, or timely manner. This is the case largely because the measures are derived from the claims data generated by a single visit.
  • The number of children and adolescents who live in poverty or in low-income families (generally considered to be below 200 percent of the federal poverty level) is higher relative to adults, a fact that has a significant influence on their health outcomes. For example, high-quality asthma care may produce marginal outcomes for children and adolescents whose housing conditions create persistent risk factors for this condition.
  • The measurement of quality of care for children with special health care needs requires attention to their functional status and care transitions as well as their health conditions. Functional status measures for children and adolescents are not standardized, however, and frequently rely on parental reports rather than comparison of a child’s behavior or skills with those of others with similar health conditions.
  • Variations in the definitions of race, ethnicity, and primary language in state databases are major obstacles to the development and use of heath care quality measures for children and adolescents. A few states have made efforts to gather demographic data by linking their Medicaid or CHIP eligibility files to their claims data sets, but such strategies are not in common use.
  • Many states and some local districts have demonstrated interest in expanding the number and types of measures used to assess quality of care, as well as in applying the measures to children and adolescents enrolled in public and private health plans. Several states and local districts already collect data that can identify early antecedents of unhealthy behaviors that may have lifelong and communitywide consequences.

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