Paying Attention to Children in a Changing Health Care System (1996) / Chapter Skim
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3 Protecting and Improving Quality of Care for Children Under Health Care Reform
3 Protecting and Improving Quality of Care for Children Under Health Care Reform
Pages 49-60
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From page 49... ...
CHAPTER 3 Protecting and Improving Quality of Care for Children Under Health Care Reform Workshop Highlights Jane S Durch, Editor Committee on Maternal and Child Health Under Health Care Reform Board on Children and Families Commission on Behavioral and Social Sciences and Education National Research Council / Institute of Medicine and Board on Health Promotion and Disease Prevention Institute of Medicine National Academy Press Washington, D.C.
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From page 50... ...
50 PAYING ATTENTION TO CHILDREN IN A CHANGING HEALTH CARE SYSTEM CONTENTS SUMMARY 51 INTRODUCTION 52 ASSESSING THE QUALITY OF CARE 53 ASSESSING CHILDREN'S HEALTH AND HEALTH CARE 54 Critical Differences Between Children and Adults, 54 More than Medical Care for Children's Health, 55 Conceptual and Methodological Considerations, 56 ASSESSING QUALITY AT SEVERAL LEVELS 57 ACCOUNTABILITY FOR CHILDREN'S CARE 58 DEVELOPING AND ENHANCING RESOURCES FOR ASSESSING CHILDREN'S CARE 59 CONCLUSIONS 60 REFERENCES 60
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From page 51... ...
Care for children emphasizes protecting and promoting healthy physical and psychosocial development whereas much adult care responds to illness. To assess children's care, ways must be developed to identify the separate effects of health care and developmental changes.
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From page 52... ...
The workshop discussions also drew attention to the need to develop better data, data collection, and data systems to support efforts to monitor and improve children's care. INTRODUCTION As actions at the state and local levels and in the public and private sectors change the financing and delivery of health care across the United States, there is concern that the quality of care must be protected and enhanced.1 Anticipated federal health care reform legislation offers the possibility of important changes in health care financing and increased access to care; it also offers a greater opportunity than in the past to ensure that the essential function of monitoring quality of care is explicitly addressed.
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From page 53... ...
In response to concern that important aspects of children's health and health care require greater attention as federal health care reform proposals take final shape and as other aspects of federal health programs are developed, the National Academy of Sciences' National Research Council (NRC) and Institute of Medicine (IOM)
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From page 54... ...
Therefore, the element of "independent functioning," which is a critical factor in judging adult health status, does not apply to children. The degree of dependency decreases over time, but in large measure children must rely on adults, as individuals or through society's various institutional structures, to provide care that promotes normal development, to recognize disorders and obtain treatment, and to define pre- and posttreatment functioning.
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From page 55... ...
Some of the services may be available from health plans or other health care providers, while others may be provided by public health agencies, often with federal support such as Maternal and Child Health Block Grant funds. Education and school-based services, which often are more removed from the realm of medical care, also make important contributions to a child's health and developmental progress.
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From page 56... ...
Health plans may have an interest in assessing how well such services are meeting the needs of member children, but public health agencies have a broader perspective that can enable them, in collaboration with providers in the private sector, to make overall assessments of these services for all children in a state or community. Conceptual and Methodological Considerations Rates of immunization, low birth weight, and hospitalization for asthma are among the handful of indicators used to monitor children's health care.
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From page 57... ...
Some measures may be useful but not appropriate for children of all ages: for example, immunization rates for 2-year-olds reflect care being given to infants and toddlers but do not provide information about care that adolescents are receiving. Children with chronic illnesses or other special health care needs receive substantial amounts of care, but the small numbers of such children make it hard to develop measures with adequate statistical power to detect meaningful differences over time or among health plans.
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From page 58... ...
Publication of performance measures for health plans may encourage those with lower ratings to make improvements so that they can compete successfully with other plans. If children's unique needs are considered, accreditation standards established by private, voluntary groups can also promote improvements in quality of care provided by hospitals, health plans, or other providers that want to achieve accredited status.
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From page 59... ...
Some at the workshop felt that authority for all quality oversight should rest with state public health agencies. They noted that the IOM has identified as core public health functions assessing health status and health needs and assuring that high quality services are available to meet those needs.3 DEVELOPING AND ENHANCING RESOURCES FOR ASSESSING CHILDREN'S CARE Throughout the workshop, presentations and discussions pointed to the need for federal assistance to support research to develop appropriate techniques and tools for assessing the quality of children's health care.
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From page 60... ...
CONCLUSIONS As changes are made in the health care system to control costs and improve access to services, changes should also ensure that the quality of care is protected and improved. To ensure that children receive appropriate care, the available, but still limited, tools for assessing their health status and health care need to be used as effectively as possible.
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