Established Child Health Care Quality Measures
Child and Adolescent Health Measurement Initiative (CAHMI): Promoting Healthy Development Survey (PHDS)
Contents
The Promoting Healthy Development Survey
(PHDS) is a survey of parents or guardians of children 3-48 months
old to assess how well health systems provide recommended preventive
and developmental health care to young children. Information is gathered
on the following issues:
- Guidance and education for parents.
- Health information.
- Parent concerns about the child's learning, development,
and behavior.
- Appropriate followup care for children who are
at risk for developmental and/or behavioral delays.
- " Assessing families for risks to the child's health.
- Family experience of care (family-centered care
and helpfulness of care).
The PHDS was developed under the
Child and Adolescent Health Measurement Initiative (CAHMI). CAHMI was
established in 1998 by the Foundation for Accountability (FACCT) and
the National Committee for Quality Assurance (NCQA) with funding from
The David and Lucille Packard Foundation, The Commonwealth Fund, the
Federal Maternal and Child Health Bureau, Centers for Medicare &
Medicaid Services, and AHRQ. The purpose of the CAHMI is to
provide leadership and resources for measuring and communicating information
about health care quality for children and adolescents. CAHMI is currently housed at Oregon State University and is guided
by a broad-based advisory committee.
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Availability
The PHDS is available in English and Spanish free
of charge on CAHMI's Web site. Guidelines for Implementing the Promoting
Healthy Development Survey are being developed and will be available
on the CAHMI Web site in July 2004. The Guidelines will include
detailed information about how to plan a PHDS project, administer the
survey via mail or telephone, and score and report the survey findings
to multiple stakeholders. Please contact CAHMI staff at cahmi@ohsu.edu
for more information.
Online Resources:
For more information on CAHMI, go to: http://www.cahmi.org
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Child Measures
Included
The PHDS assesses the following aspects
of preventive and developmental care for young children:
- Whether parents receive
anticipatory guidance and parental education from health care providers
on topics such as:
- Physical care of child.
- Child development and
behavior.
- Protecting the child
from injuries.
- Health information.
- Followup for children
at risk for developmental, behavioral, or social problems.
- Parent concerns.
- Assessment of psychosocial
well-being and safety in the family.
- Assessment of smoking,
drug, and alcohol use in the family.
- Family-centered care
(experience of care).
- Helpfulness of care provided.
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Users
The PHDS is used to assess health care
quality at the national, State, county, geographic region, health plan,
medical group, office, and individual health care provider level.
Users of the PHDS include:
- Three health
plans (two in California, one in Ohio) as part of their quality improvement
projects.
- The State
of Maine as part of its Medicaid quality improvement effort. The
State did analysis at the program level—fee-for-service (FFS) or primary-care
case management (PCCM); by geographic region (rural, urban), and at
the health care provider level.
- The State
of Washington as part of its Medicaid quality improvement
efforts. The State did analysis at the health plan, program (FFS, PCCM),
and county level.
- The PHDS
was administered to Medicaid clients in Washington, Vermont, and North Carolina. The results provided baseline data for
these States' improvement efforts via the Assuring Better Child Health and Development (ABCD) initiative funded by The Commonwealth Fund and directed by the National
Academy for State Health Policy (NASHP).
- The National
Survey of Early Childhood Health (NSECH) used components of the PHDS
to collect information about the quality of health care delivered to
young children.
-
Two medical groups, comprising
5 participating office sites and over 15 individual health care providers,
implemented the mail-based PHDS and administered a reduced-item version
of the PHDS in their pediatric offices.
Online Resources:
Examples of reports generated from these field trials
and PowerPoint presentations that highlight key findings from these
applications are available on the CAHMI Web site. Go to: http://www.cahmi.org
For more information
on the National Survey of Early Childhood Health, go to: http://www.cdc.gov/nchs/about/major/slaits/nsech.htm
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Comparisons
and Trends
PHDS results can be used for statistically
significant comparisons among health plans, programs, and health care
providers. Results can also be used for trending over time provided
that the same or comparable populations are being surveyed and that
the same mode of administration and version of the PHDS instrument are
used.
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Benchmarking
and Databases
CAHMI has worked collaboratively with
all PHDS users and has maintained data related to these applications.
However, at this time there are no benchmarking data publicly available
that could allow users to compare their findings to those of other users.
NSECH findings are available on the Centers for Disease Control and Prevention (CDC) Web site. Many of the items in the NSECH that focus on assessing the quality of preventive and developmental health care are derived from the PHDS.
Online Resource: For additional information
on the CDC, go to:
http://www.cdc.gov/nchs/about/major/slaits/nsech.htm
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Service Delivery
and Units of Analysis
PHDS data can be collected and analyzed
for multiple units of analysis:
- Geographic region (national,
State, county).
-
Program level (health
plan, PCCM, or FFS).
-
Medical group.
-
Office level.
-
Individual health care
provider and/or provider teams of a doctor and nurse.
-
Child and/or parent health,
health care, and sociodemographic characteristics.
Results of the PHDS can be used to
report eight composite measures assessing domains of preventive and
developmental health care recommended for young children:
- Guidance and education
for parents by a doctor or other health provider.
-
Health information.
-
Followup for children
at risk for developmental, behavioral, or social problems.
-
Parent concerns.
-
Assessment of psychosocial
well-being and safety in the family.
-
Assessment of smoking,
drug, and alcohol use in the family.
-
Family-centered care
(experience of care).
-
Helpfulness of care provided.
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Length-of-Enrollment
Requirements
The length-of-enrollment requirements
depend on the purpose for implementing the PHDS and upon the place of
administration.
- The in-office administration
of the PHDS to assess at the office or individual health care provider
level has a visit-based requirement rather than an enrollment-based
requirement. This is because most pediatric offices do not have "enrolled"
children and the survey is instead given to parents whose children receive
health care at the office.
- For administration at
the health plan level, the PHDS recommends that Medicaid children be
enrolled at least 6 months, with a break of no more than 30 days. Children
with employer-based insurance must be enrolled at least 12 months, with
a break of no more than 45 days.
- These rules generally
apply to other assessments at the program (PCCM, FFS) and other levels.
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Data Issues
The PHDS can be administered by:
- Mail.
- Telephone.
- Paper-pencil format at the health care provider's office.
The forthcoming Guidelines
for Implementing the Promoting Healthy Development Survey will provide
detailed information about how to plan a PHDS project, administer the
survey via mail or telephone, and score and report the survey findings
to multiple stakeholders.
The In-Office Administration of
the PHDS-Reduced Item Survey, available
on the CAHMI Web site, provides detailed information about how to implement
a reduced-item survey in office settings where health care is provided
to young children. Go to: http://www.cahmi.org.
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Sample Sizes
The forthcoming Guidelines
for Implementing the Promoting Healthy Development Survey will provide
detailed information about the sample sizes needed for specific applications
of the PHDS.
The In-Office Administration of
the PHDS-Reduced Item Survey provides detailed information about
sample sizes needed to assess at the office and/or health care provider
level.
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Resource and
Burden Issues
The production of performance measures
is a data-driven activity. Credible survey data require close attention
to proper sampling methods and adherence to survey administration protocols.
These take time and money. Senior-level agency responsibility and sufficient
staff resources are needed to ensure useful results.
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Development
Process
The PHDS was developed and tested through
support from The Commonwealth Fund. It is one of three measurement sets
recommended for use by the national advisory committee of the CAHMI.
A standard and rigorous six-stage process was used
to develop the PHDS, beginning with focus groups with families to identify
the aspects of health care quality that are important to parents in
the area of preventive care for their children. A review of the literature
was conducted, including over a dozen parent surveys on early childhood
development, family-centered care, and other topics; encounter forms;
and checklists used by clinicians to help with the provision of anticipatory
guidance and the assessment of young children and their families.
The six-stage development process included:
- Development of conceptual framework
and investigation of relevance of measure.
- Development of a starting-point
measurement proposal, including initial feasibility studies.
- Development of draft instrument
and implementation methodology.
- Field testing (minimum of three
sites).
- Revision and refinement of survey,
survey administration protocol, and scoring protocol.
- Development of scientific and technical
documentation and larger scale implementation and dissemination.
In the early stages of developing the
PHDS, many existing surveys and tools were reviewed, particularly those
methods designed to evaluate the Healthy Steps project or previously
validated survey-based tools (e.g., Parental Evaluation of Development
Status). Although many of the PHDS survey concepts reflect those represented
in these surveys and tools, nearly all of the PHDS items were newly
developed due to a lack of available, tested candidate items appropriate
for performance assessment in a self-administered survey. The PHDS is
the first parent-reported survey specifically designed and tested for
comprehensive performance assessment of preventive and developmental
health care for young children.
Three advisory groups
within the CAHMI, comprised of pediatricians, family practitioners,
consumer representatives, public health experts, and researchers, regularly
reviewed and provided input on the identification of quality measurement
topics and the development of the PHDS.
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Criteria
Used
The following criteria were used to
select topics assessed in the PHDS survey:
- Appropriateness for all
children 3-48 months old.
- Strength of scientific
evidence.
- Professional consensus.
- Lack of more reliable,
valid, or efficient way to measure the topic.
- Importance of topic to
parents as ascertained from cognitive interviews and focus groups.
- Ease with which topic
can be validly and reliably reported by parents.
- Parsimony (e.g., topic
is not already largely represented by another, related topic in the
PHDS).
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More Information
and User Support
Online Resources:
Partnering with Parents to Promote the
Healthy Development of Young Children Enrolled in Medicaid, the results of the PHDS survey conducted in three States,
is available on the CAHMI Web site. Go to: http://www.cahmi.org.
More information about the PHDS survey
development process can be found in "Assessing health system provision
of well-child care: The Promoting Healthy Development Survey," an article
by Christina Bethell, Colleen Peck, and Edward Schor published in the
May 2001 issue of Pediatrics—107(5):1084-94.
Abstract available on PubMed®:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11331691&dopt=Abstract
For more information, contact CAHMI staff at cahmi@ohsu.edu or visit CAHMI's Web site. Go to:
http://www.cahmi.org
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Overview / CAHPS® / AHRQ QIs / HEDIS® / Title V / CAHMI-YAHCS
State Report Examples / Mental Health Quality Measures
Internet Citation:
Child Health Care Quality Toolbox: Established Child Health Care Quality Measures—Child and Adolescent Health Measurement Initiative (CAHMI): Promoting Healthy Development Survey (PHDS). August 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/chtoolbx/measure6.htm
540 Gaither Road Rockville, MD 20850