Current HEDIS measures (1999)
Access to care
o Proportion of children ages 12-24 months, 25 months to 6 years, and 7 years to 11 years who had at least one visit with a primary care provider during the reporting year
o Satisfaction with care
o Pediatric version of Consumer Assessment of Health Plans survey for parents of children 12 and under
Preventive care
o Proportion of children who received appropriate immunizations prior to their second birthday
o Proportion of 13-year-olds who were appropriately immunized during the year
o Proportion of children who received well-child visits in their first 15 months of life
o Proportion of children ages 3 to 6 who received one or more well-child visits during the reporting year
o Proportion of adolescents ages 12-21 who had at least one comprehensive well-care visit during the reporting year
o Proportion of children or adolescents ages 4-21 who had an annual dental visit
Available and Emerging Children’s Health Quality Measures
The Foundation for Accountability in Portland, OR, has identified these measures for health plan performance assessment in children’s health care. Measures marked with an asterisk are ready or nearly ready for use. Other measures are in development or are planned for future development.
The Basics
A. What people say about getting needed care and service
— Consumer Assessment of Health Plans (CAHPS): Ease of Access scale*
— CAHPS Communication and Involvement scale*
— CAHPS Service, Hassles, and Responsiveness scale*
B. Plan features that may influence getting needed care and service
— Provider capacity*
— Pediatric-specific medical necessity*
— Salary withholds and quotas for primary care physicians*
— Provider turnover and satisfaction*
— Restrictions on time with clinicians*
— Change in ownership*
C. Community accountability and involvement
— Community linkages*
— Culturally competent
— Community-oriented governance*
Staying Healthy
A. Steps to good care
— Adherence to well-child care visit periodicity schedules*
— Adolescent report on preventive counseling
— Immunization rates*
— Family/parent education and support to promote the healthy development of children (adherence to Bright Futures and/or U.S. Preventive Health Services Task Force recommendations)
— Counseling and follow-up to prevent repeat injuries and other preventable problems
B. Results of care
— Adolescent health risk behavior and knowledge
— Rate of repeat injuries, preventable conditions such as bottle mouth
— Reduction of risk behaviors
— Family health/health behavior essential to promoting the healthy development of children
Getting Better
A. Steps to good care
— Family/parent education and support for preventing and managing acute conditions in children
— Follow-up after testing, diagnosis, emergency department treatment, or hospitalization
— Composite measure combining information about the prevention of key processes of care across a number of common acute illnesses in children (to allow for sufficient sample sizes)
— Clinical measure(s) expected from RAND Global Quality Assessment Tool (primarily chart review)
— Results of care
— Rate of avoidable hospitalization due to acute illness*
— Recovery from illness
Living with Illness
A. Experience with care
— Pediatric CAHPS Chronic Conditions Survey Sub-scales
B. Steps to good care
— Provision of family, child, adolescent education, counseling, and support, including care plan
— Composite measures on the provision of appropriate clinical services and procedures (combines with information across a number of chronic conditions to allow for sufficient sample sizes)
— Clinical measure(s) expected from RAND Global Quality Assessment Tool (primarily chart review)
C. Results of care
— Lost time from school or work
— General and condition-specific functioning, coping and quality of life
— Avoidable acute episodes of chronic illness
— Symptom relief and control
— Presence of essential knowledge, skills, and behaviors in families and children
Changing Needs
A. Experience of care
— Patient and family satisfaction with communication, level of trust, involvement in decision making with care of major disabilities and care at end of life
B. Steps to good care
— Process to support function and autonomy
— Caregiver support
— Pain management planning/processes
— Advance care planning/processes
C. Results of care
— Physical and emotional symptoms (pain and comforting)
— Global quality of life
— Family burden
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