Up until now, much of the quality data collected by health plans on children nationwide focused on measures that indicated if care was received—for instance, were immunizations up to date or had well-child visits been completed. Changes may be afoot, though, as the National Committee for Quality Assurance, working with The Commonwealth Fund, looks to get a broader view of well-child care with expanded quality measures.
These older process measures "don't tell us what happened," said Sarah Scholle, DrPH, NCQA's assistant vice president of research and analysis and co-author of NCQA's new report on Quality of Child Health Care: Expanding the Scope and Flexibility of Measurement Approaches released on Thursday. For instance, did a child have a specific developmental screening during a visit or was an adolescent counseled about risky behaviors or vehicle safety?
Over the years, the public and private sectors have invested less in quality measurement and standardization for children than for adults, according to Scholle. However, the recent passage of the Children's Health Insurance Program Reauthorization Act is expected to change that. The legislation directs the Health and Human Services secretary to identify a core set of quality measures for all state-run Medicaid and CHIP programs to collect starting in 2010.
In order to decide which measurement tools to include, a panel of child health experts was convened last year to identify a strategy. To start out, NCQA is evaluating a framework for prevention that includes measures at specific milestone ages: before an infant turns six months old and by a child's 2nd, 6th, 13th, and 18th birthdays. The areas of focus are: protection of health, healthy development, safe environment, and management and follow-up of health problems.
Incorporating these measures would mean, for instance, monitoring if an infant had a newborn metabolic screening or physical growth assessment; if a toddler had a lead screening or an autism screening; or if an adolescent had a blood pressure assessment or weight assessment or counseling.
"NCQA would consider incorporating measures in our HEDIS (Healthcare Effectiveness Data and Information Set) data set for health plan reporting, as well as whether there are opportunities to use it for evaluating care at the physician level," Scholle said.
NCQA is currently preparing detailed measure specifications and will conduct a field test of proposed comprehensive well-care topic areas. An issue brief on the quality of child healthcare is available from the Commonwealth Fund.