Child and Adolescent Health and Health Care Quality Measuring What Matters (2011) / Chapter Skim
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6 Conclusions and Recommendations
6 Conclusions and Recommendations
Pages 175-208
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From page 175... ...
Such information enables society to compare the relative health of the nation's young people and the youth of other nations, as well as specific subgroups of American youth -- defined by geography, race, socioeconomic status, or other characteristics -- so we can make the policy and program changes that can achieve national health and health care goals. Similarly, measurement of the quality of children's health care enables society as a whole to understand the value of investments in health care services so as to make better decisions about these investments.
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From page 176... ...
The first set focuses on the nature, scope, and quality of existing data sources with information about child and adolescent health and health care quality. The second set involves conclusions about gaps in measurement areas that provide opportunities for improving future data collection, analysis, and reporting efforts broadly.
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From page 177... ...
• Standardized measures of child health and the quality of relevant health care are important for all child health problems, but espe cially for preventable, ongoing, or serious health conditions. More over, the implications of the existence of a health condition may vary with the age of the child or adolescent.
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From page 178... ...
• The health of other family members, especially parents and other caregivers, may directly affect the health of children and adoles cents, as well as their access to and use of health care services. Family-focused measures (e.g., the health conditions affecting par ents, their employment status, and family and household structure)
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From page 179... ...
. Current child and adolescent health measures lack the capacity to capture important functional and developmental data; however, valid measures in these areas that have been tested across diverse populations do not yet exist.
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From page 180... ...
level, length of plan enrollment, and eligibility criteria; and -- selected health conditions (such as asthma or mental health dis orders) and parental health status.
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From page 181... ...
• While it is often difficult to connect data from the clinical records of children and adolescents enrolled in public health insurance plans to population health surveys and administrative data sets, such efforts will increase understanding of the social context and life-course influences that may affect children's health status and their access to and use and quality of health care services (IOM and NRC, 2004, p.
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From page 182... ...
The absence of strong private-sector incentives for the measurement of health care quality in younger populations, coupled with the compelling need to improve health care quality and population health outcomes for underserved children and adolescents, supports the need for a strong public presence in the design, collection, use, and reporting of such measures. In reviewing early efforts and recent initiatives focused on improving health and health care quality measures for children and adolescents, the committee sought to build on the experience gained from earlier Institute of Medicine (IOM)
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From page 183... ...
health plans. Step 2 -- Develop annual reports and standardized measures based • on existing data sets of health and health care quality that can be collected and used to assess progress toward those goals.
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From page 184... ...
The entire approach is supported by research and evidence; survey, administrative, and medical records data; the health information infrastructure; and stakeholders. The committee's primary objective is to set in motion a process by which progress that has been achieved in identifying key domains for measuring the health of children and adolescents -- by going beyond health conditions to assess health functioning, health potential, and health influences -- can be incorporated into existing and future efforts to measure the quality of health care for these populations.
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From page 185... ...
Improve public → Feasibility 4. Improve data and private collection, capacity to use reporting, and and report data analysis FIGURE 6-1 A stepwise approach to measuring health and health care quality for children and adolescents.
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From page 186... ...
E HHS Data Council • outinely convene experts in public health, health care quality, and data R sources associated with public and private health plans to identify opportuni ties for coordinated and integrated measures of preventive services for children and adolescents. • oordinate with HHS agencies to validate functional and developmental mea C sures that can apply to chronic health conditions for children and adolescents in existing data sets.
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From page 187... ...
• ncourage collaboration with the National Health Information Network, the Key E National Indicators Initiative, and related efforts to create community health maps and develop "smart targeting" techniques that focus on the status and particular needs of children enrolled in Medicaid and CHIP plans, as well as other vulnerable populations of children and adolescents. • onvene state-based health plans to identify measures for key preventive C health care strategies that could be incorporated into the core set of priority health care quality measures for children and adolescents.
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From page 188... ...
They could also be reported as part of the annual national quality strategy and national prevention strategy reports prepared by the Secretary of HHS. In addition to specifying these goals, HHS agencies will need to establish lead agency roles in coordinating data linkage efforts.
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From page 189... ...
, changes in the environmental context for individual decision making (such as the use of protective equipment) , and strategies addressing socioeconomic factors that influence health status (such as reducing poverty or increasing educational achievement)
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From page 190... ...
These initiatives warrant increased support because of their capacity to inform the next generation of health care quality measures, as well as the emerging health information technology infrastructure. Population health data sources, in particular, offer valuable resources to support new health care quality measures that go beyond traditional measures associated with treatment for acute and chronic disease.
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From page 191... ...
While a large number of measures exist, efforts to monitor and improve the health and health care quality of children and adolescents are hampered by the absence of routine annual reports that focus on child and adolescent health and health care quality, as well as variations in both the measures themselves and the underlying data sources that support them. In the latter area, the committee has identified two issues of particular concern: (1)
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From page 192... ...
This is a recurrent theme throughout this report, as reflected in the committee's recommendations and the suggested key implementation actions outlined below and summarized in Box 6-1. The composition of population groups that are represented in existing data sets, as well as the methodological limitations of the survey measures and administrative data themselves, deserve significant attention.
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From page 193... ...
Disparities in health and health care can be assessed by collecting data on race/ethnicity, socioeconomic status, special health care needs, primary language spoken at home, and parental English proficiency for all children and adolescents. Specific actions that could be taken to implement this recommendation include the following: • All HHS agencies, especially AHRQ and CMS, could assess their current capacity to identify the social and economic status of chil dren and adolescents in national and statewide data sources and take steps to introduce associated measures where they are not available.
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From page 194... ...
, -- early childhood preventive care services and school readiness, -- transitions from adolescence to young adulthood, -- children with special health care needs (e.g., Down syndrome, cystic fibrosis) , -- oral health, -- mental and behavioral health (including substance abuse)
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From page 195... ...
Strengthening these efforts while providing additional funding to those states without these capacities can make the improvement of national child and adolescent health data more feasible. States often are required to report important data in such areas as health events and service provision as a condition for receipt of federal funding.
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From page 196... ...
STEP 3: CREATE NEW MEASURES AND DATA SOURCES IN PRIORITY AREAS As noted above, most of the current health and health care quality measures for children and adolescents are focused on significant causes of mortality and morbidity and chronic health conditions (Beal et al., 2004)
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From page 197... ...
These measures should focus on common health conditions among children and adolescents, especially in the areas of oral health and mental and behavioral health, including substance abuse. The new National Prevention Strategy mandated in the Affordable Care Act offers an opportunity to improve the quality of data sources with respect to the measurement of preventive services for children and adolescents.
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From page 198... ...
. Measures Addressing Social and Behavioral Determinants of Health Using a Life-Course Perspective While the need for improved measures of health care disparities and preventive services has already attracted attention, few data sources currently provide opportunities to incorporate new measures in such areas as the social and behavioral determinants of health or incorporate a life-course approach to measuring health functioning and health potential.
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From page 199... ...
• The HHS Data Council could coordinate with HHS agencies to validate functional and developmental measures that can apply to chronic health conditions for children and adolescents in existing data sets. This effort would involve testing similar measures of functional status across different health conditions and popula tions to establish thresholds and categories and to highlight key dimensions of functional status, including calibration of parental/ youth reporting and intervention strategies.
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From page 200... ...
Longitudinal data focus atten tion on the sequence of conditions, experiences, and resources that influence child health outcomes. Infant mortality rates in certain re gions, for example, may result not from the scarcity or low quality of neonatal facilities but from the absence of high-quality prenatal care for pregnant women, especially those who have difficulty navi gating health care services because of limited English proficiency, changes in employment or family structure, or low health literacy.
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From page 201... ...
to identify op portunities to support state and local efforts that link health data for children and adolescents with school performance and commu nity safety indicators, with special consideration of the challenges created by HIPAA and FERPA regulations. • The Federal Interagency Forum on Child and Family Statistics could work with other federal agencies to develop strategies for integrating multiple data sets into a comprehensive data system capable of monitoring influences on children's health outcomes, including -- environmental indicators that inform analyses of interactions between health influences and child health conditions; -- geographic indicators that facilitate comparisons of health and nonhealth factors linked across population health survey(s)
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From page 202... ...
In addition, longitudinal measurement is necessary to determine both the short- and long-term outcomes of care, identifying intervening factors that may enhance or impede the effects of a high-quality health care system. Creating opportunities to link data across multiple health care settings, as well as connecting health and health care data to education and human service data sources, will improve timeliness and foster greater transparency as to the multiple factors that affect the well-being of children and adolescents.
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From page 203... ...
Accessibility is critical as well if the data are to inform public discourse and lead to prompt action. Linking data across multiple health care settings, as well as linking administrative records to education and human service data systems, will improve timeliness and foster greater transparency as to the multiple factors that affect the health and health care quality of children and adolescents.
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From page 204... ...
• AHRQ and CMS could develop a series of demonstration experi ments involving the use of unique identifiers to foster life-course analyses and to strengthen the capacity to link records across mul tiple health care settings, as well as to link health data with sources of education and community safety data. Such experiments should build on innovative local and regional models that are already employing unique identifiers in data warehouses, such as the Kids Integrated Data Set (KIDS)
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From page 205... ...
Efforts to build federal, state, and even local capacity for place-based measures can resolve some of the current difficulties of integrating health measures, measures of social context and other health influences, and health care quality measures focused on services within the health care setting. Such efforts will require innovative approaches to compiling and extracting data from existing surveys and databases.
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From page 206... ...
Recommendation 10: The Secretary of HHS should establish a timetable for all states to report on a core set of standardized measures that can be used in the health information technology infrastructure to assess health and health care quality for children and adolescents. Congress and HHS should formulate alterna tive strategies (through incentive awards, demonstration grants, and technical assistance, for example)
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From page 207... ...
. Such studies would focus attention on selected reference groups that require more intensive and coordinated strategies be cause of their high rates of mobility, frequent turnover with mul tiple health plans, and high risk of poor health conditions.
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From page 208... ...
Implementation of the recommendations presented in this chapter call for strong national and state-based leadership, as well as modest additional resources to go beyond traditional boundaries and incorporate data elements that can deepen our understanding of the complex interactions among health, health care quality, and the social determinants of health for children and adolescents. Innovations in electronic technologies and data gathering methods offer opportunities to create new measures that can inform our understanding of important health disparities, preventable health conditions, the social determinants of health, and a life-course approach to the assessment of health and health care quality for America's children and adolescents.
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