Child Health Quality Research Articles

Lessons Learned from Hospital Leaders Who Participated in a National Effort to Improve Maternity Care Practices and Breastfeeding

As a method to increase exclusive and overall breastfeeding, the Centers for Disease Control and Prevention funded the National Institute for Children's Health Quality to run a national collaborative designed to accelerate the number of Baby-Friendly-designated hospitals in the United States. A unique aspect of this project was the development of the first ever national quality improvement collaborative of hospital leaders focused on maternity care practices and breastfeeding. Members of the Leadership Track were continually engaged and surveyed throughout the project period to provide feedback on the collaborative process and project as a whole. The Leadership Track served as a vital catalyst for change, resulting in an unprecedented number of newly designated Baby-Friendly hospitals. A quality improvement Leadership Track adds value and provides lessons learned that can be applied to other complex healthcare initiatives affecting global policies and public health.

State challenges to child health quality measure reporting and recommendations for improvement

ObjectiveThe Children's Health Insurance Program (CHIP) was re-authorized in 2009, ushering in an unprecedented focus on children's health care quality one of which includes identifying a core set of performance measures for voluntary reporting by states' Medicaid/CHIP programs. However, there is a wide variation in the quantity and quality of measures states chose to report to the Center's for Medicare & Medicaid Services (CMS). The objective of this study is to assess reporting barriers and to identify potential opportunities for improvement. MethodsFrom 2013 to 2014 a questionnaire developed in coordination with CMS and the Agency for Healthcare Research and Quality (AHRQ) was sent to state Medicaid and CHIP officials to assess barriers to child health quality reporting for Federal Fiscal Year 2012. States were categorized as high, medium, or low reporting for comparative analysis. ResultsTwenty-five of the 50 states and the District of Columbia agreed to participate in the study and completed the questionnaire. States placed a high priority on children's health care quality reporting (4.2 of 5 point Likert Scale, SD 0.99) and 96% plan to use measurement results to further improve their quality initiatives. However, low reporting states believed they had inadequate staffing and that data collection and extraction was too time-consuming than high reporting states. ConclusionBased on state responses, possible solutions to improve reporting includes funding and staff support, refining the technical assistance provided, and creating venues for state-to-state interaction. Realistic and tangible improvements are within reach and opportunities for CMS and states to collaborate to improve child health care quality.

Confessions of a Square Peg

Confessions of a Square Peg

Rural Clinician Evaluation of Children's Health Care Quality Measures: An Oregon Rural Practice-based Research Network (ORPRN) Study.

Responding to quality metrics is an accepted and expected component of the current health care environment. Little is known about which measures physicians identify as a priority when reporting the quality of care to their patients, especially the care of children in rural settings. The objective of this study is for physicians caring for children in rural communities to identify which of the initial core sets of 24 child health quality measures are useful and are a priority for reporting and improving care. A survey was sent to rural Oregon physicians who provide care to children. Of 955 eligible physicians, 172 (18%) completed the survey. The majority of respondents were family physicians (84%), and most respondents (58%) were in private practice. The child health measures stratified into 3 priority tiers: high, medium, and low priority. The top-tier priority measures included childhood immunization status, well-child visits, adolescent immunization status, body mass index assessment, and developmental screening. Dental treatment services, adequate prenatal care, and lower-birth-weight infants were among the lower-tier measures. The priority measures identified by rural family physicians reflect the relevance of the selected measures to their daily practice responsibilities, with missed opportunities to improve community health.

English

BACKGROUND AND OBJECTIVES: Perinatal mortality is the most sensitive index of the efficacy of not only antenatal, intranatal care and the quality of child health but also of socioeconomic status of the community. This study was aimed to assess the perinatal mortality rate and determinants of perinatal mortality at a tertiary care centre. METHODOLOGY: This retrospective hospital based study included all the perinatal deaths (> 20 weeks / > 500 gms) and neonatal deaths (within 28 days of birth) during the period from 2008 to 2012. Data regarding maternal age, booking status, mode of delivery, sex of baby, birth weight, congenital anomalies and probable cause of death were collected. RESULTS: The PMR was found to be 47.95 per 1000 births. The PMR during 2008 was at peak with 58.72 per 1000 births which gradually showed a trend towards reduction with minimum at 39.57 per 1000 births during 2012. The PMR was high among the women who were aged between 20 to 30 years while it was comparable in women with primi and multi parity. Most of the mothers were unregistered for ANC (64.84%) and vaginal delivery was noted in 76.65% of the mothers. The mortality was found to be high in fetus 3.5 Kgs (1.24%). The commonest cause of PMR was placental abruption (17.6%). CONCLUSION AND INTERPRETATION: There Is a strong need to strengthen the educational and communication activities to create awareness about antenatal health care, identification of high risk mothers, timely referral, advanced life support of preterm neonates which would help in reducing the PMR.

National Quality Measures for Child Mental Health Care: Background, Progress, and Next Steps

To review recent health policies related to measuring child health care quality, the selection processes of national child health quality measures, the nationally recommended quality measures for child mental health care and their evidence strength, the progress made toward developing new measures, and early lessons learned from these national efforts. Methods used included description of the selection process of child health care quality measures from 2 independent national initiatives, the recommended quality measures for child mental health care, and the strength of scientific evidence supporting them. Of the child health quality measures recommended or endorsed during these national initiatives, only 9 unique measures were related to child mental health. The development of new child mental health quality measures poses methodologic challenges that will require a paradigm shift to align research with its accelerated pace.

Does implementation of the IMCI strategy have an impact on child mortality? A retrospective analysis of routine data from Egypt

BackgroundBetween 1999 and 2007, the Ministry of Health and Population in Egypt scaled up the Integrated Management of Childhood Illness (IMCI) strategy in 84% of public health facilities.ObjectivesThis retrospective analysis,...

How Can Quality Improvement Enhance the Lives of Children with Disabilities?

Much attention has aided measurement and improvement in the quality of health care during the past two decades, with new ways to define and measure quality, recognition that doing so can identify strategies to enhance care, and systematic efforts by both government and private insurers to apply these principles. In this article, James Perrin reviews these gains. Although children have benefited, these quality measurement efforts have focused mainly on adult health care. Now, two recent federal programs promise to expand quality measurement of child health care. Enacted in 2009, the Children's Health Insurance Program Reauthorization Act provides systematic support for efforts to develop and implement a set of child health quality measures. This federal support represents the first major public investment in improving child health care quality. The Affordable Care Act, which became law in 2010, extends those activities by focusing attention on improving care for people with chronic conditions, including new ways to organize care using teams of doctors, nurses, and others focused on improving chronic care outcomes. For children especially, this team care should also focus on prevention of chronic conditions and their consequences. Despite these significant efforts to expand quality measurement among children and youth, Perrin finds that most measures and improvement activities focus on children without chronic conditions, and few measures of chronic conditions go beyond examining what kinds of monitoring children with specific conditions receive. Only limited attention is paid to how well the children are functioning. A number of networks working with children with specific chronic health conditions (such as cancer, cystic fibrosis, and sickle cell disease) have developed effective measures of functioning for children with those conditions and active programs to improve such outcomes. These networks offer the best examples of how to improve care and outcomes for young people with disabilities. Broadening their impact to larger numbers of children with disabilities will require developing measures of functioning and quality of life and targeting interventions and efforts to improve those outcomes.

Putting child mortality on a map: towards an understanding of inequity in health

To map and analyse geographical (spatial) variations of child mortality trends in mainland Tanzania. We used a geographic information system to integrate data on child mortality and associated risk factors. We then applied spatial statistics to quantify the spatial component of child mortality trends, and employed multivariate analysis to break mortality down into a spatial and a local component. The results support our hypothesis that child mortality trends have a spatial component that can be attributed to broad-scale environmental and social-economic factors. However, the multivariate analysis showed that the spatial component only explained one-third of the variation in child mortality trends. The results thus point towards the presence of local (non-spatial) causative factors, including variations in the access to and quality of child health care. The method we used is a cost-effective way to systematically assess geographical variations in health outcomes. It can thus provide researchers and practitioners with a good first-line tool in understanding local contributions to differences in mortality and other indicators, and give authorities at all levels a better foundation for addressing health inequities.

Integrated Management of Childhood Illness: efficiency of primary health in Northeast Brazil

The Integrated Management of Childhood Illness is a strategy designed to address major causes of child mortality. The aim of this study was to assess the impact of the strategy on the quality of child health care provided at primary facilities. Child health quality of care and costs were compared in four states in Northeastern Brazil, in 2001. There were studied 48 health facilities considered to have had stable strategy implementation at least two years before the start of study, with 48 matched comparison facilities in the same states. A single measure of correct management of sick children was used to assess care provided to all sick children. Costs included all resources at the national, state, local and facility levels associated with child health care. Facilities providing strategy-based care had significantly better management of sick children at no additional cost to municipalities relative to the comparison municipalities. At strategy facilities 72% of children were correctly managed compared with 56% in comparison facilities (p=0.001). The cost per child managed correctly was US$13.20 versus US$21.05 in the strategy and comparison municipalities, respectively, after standardization for population size. The strategy improves the efficiency of primary facilities in Northeastern Brazil. It leads to better health outcomes at no extra cost.

Measuring the Quality of Children’s Health Care: A Prerequisite to Action

To assess the availability and use of quality measures for children's health care, highlight promising developments, and develop recommendations for future action steps by the child health quality measurement and improvement fields, pediatrics, and the national quality of care enterprise generally. Two-day invitational expert meeting, informed by 3 commissioned articles. Quality of care for children is far less than optimal. A number of measures are available for measuring children's health care quality on a regular basis, although measures are scarce at least in many areas (eg, pediatric patient safety, end-of-life-care, mental health care, oral health care, neonatal care, care for school-aged children, and coordination of care). Many of the available measures are not being applied regularly to measure the quality of children's health care; barriers to implementation include lack of an information infrastructure that is child- and quality-friendly and lack of public support for improving children's health care quality. To improve the availability and use of quality measures for accountability and improvement, meeting participants recommended that at least 4 activities be national priorities: 1) build public support for quality measurement and improvement in children's health care; 2) create the information technology infrastructure that can facilitate collection and use of data; 3) improve the reliability, validity, and feasibility of existing measures; and 4) create the evidence base for measures development and quality improvement. Although substantial progress has been made in the development of quality measures and the implementation of quality-improvement strategies for children's health care, interest in quality of care for children lags behind that for adult conditions and disorders. Making significant progress will require not only sustained attention by those concerned about improving children's health and health care but also activities to build a broad base of support among the public and key health care decision-makers.

Implementing and Using Quality Measures for Children’s Health Care: Perspectives on the State of the Practice

Implementing and Using Quality Measures for Children’s Health Care: Perspectives on the State of the Practice

Presión asistencial, frecuentación y morbilidad pediátrica en un centro de salud. Diferencias etarias y estacionales

To inform on the demand for primary care paediatric services, with a view to improving health care delivery. Observational retrospective study. Estella Health Centre (Navarra). All patients attended during 1999 at one of the two paediatric clinics at the health centre. They were divided by ages into breast-feeders (0-12 months), pre-school (1-5 years old), primary school (6-9) and adolescents (10-14). The date, sex, age, type of consultation (on demand/scheduled) and health problem (CIPSAP-2) of the 6611 consultations were recorded. Frequency of visits, care pressure and seasonal distribution, related to age and type of consultation, were calculated. There were 4600 on-demand consultations (69.6%) and 2011 scheduled ones (30.4%). Total frequency of attendance was 5.46, which was greater in on-demand pre-school children (6.4) and scheduled breast-feeders (13.3). Overall patient pressure was 28.2, though less (p < 0.05) in the summer months. The most common health problems in on-demand consultations were respiratory illnesses (52.8%), infectious diseases (7.5%), neuro-sensory problems (6.8%), accidents (6.0%) and digestive problems (4.7%). There was negative correlation (p < 0.05) between age and the prevalence of respiratory diseases, whereas age was directly proportional (p < 0.05) to the prevalence of accidents and locomotive illnesses. Respiratory and infectious diseases were more common (p < 0.05) in the autumn and winter months. Paediatrics at a health centre suffers patient overload, with acute illnesses of the respiratory apparatus, and to a lesser extent infectious diseases, the main causes of consultation. Health check-ups are becoming steadily more important. There needs to be better coordination between PC teams in order to unify diagnostic and therapeutic criteria, for the more thorough non-hospital paediatrics becomes, the greater its effect on improving child health quality.

Annual Report on Access to and Utilization of Health Care for Children and Youth in the United States–1999

The dynamics of health care delivery for children and adolescents have greatly evolved over the last 5 years. The growth of managed care has been especially rapid, and has coincided with other fundamental changes—declines in private coverage, growth of Medicaid, welfare reform, and the creation of the state Child Health Insurance Program (CHIP).1 Over the past 10 years, the number of children covered through employer-sponsored plans and other private plans has dropped.2 During this same period, changes to Medicaid have begun to de-couple eligibility from welfare eligibility, theoretically enabling states to expand coverage. For children, this movement from private to public coverage has accelerated the movement to managed care systems. Between 1991 and 1997, Medicaid enrollment in managed care plans increased from 9.5% to 47.8% of total Medicaid enrollment.3 Recent estimates suggest that over half of these Medicaid managed care enrollees are children.4 However, little is known about the impact of these trends on children's access to and use of services, let alone the quality and outcomes of that care. This report is the first in what is anticipated to be an annual series of reports on access to and use of health care services by America's children and youth. The report capitalizes on the existence of 2 national datasets, the Medical Expenditure Panel Survey (MEPS) and the Healthcare Cost and Utilization Project (HCUP), which have not been widely used by the child health services research community. As background to these new sources of data, we have provided a detailed description of the datasets, and review some of the fundamental tabulations. In future years, as more data are accumulated, these reports will focus on delineation of key trends and analyses addressing policy issues. ### MEPS The MEPS is conducted to provide nationally representative estimates of health care use, …