Established Child Health Care Quality Measures
Child and Adolescent Health Measurement Initiative (CAHMI): Young Adult Health Care Survey (YAHCS)
Contents
The Young Adult Health Care Survey
(YAHCS) is a survey of adolescents 14-18 years of age that assesses
how well the health care system provides adolescents with recommended
preventive care. The YAHCS assesses the following aspects of care:
- The provision of private and confidential care.
- Preventive counseling and screening.
- Experience of care, helpfulness of care provided.
The YAHCS 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
English and Spanish versions of the YAHCS are available
free of charge on CAHMI's Web site. Guidelines for Implementing the
Young Adult Health Care Survey will be available on the CAHMI Web
site in July 2004. The Guidelines will include detailed information
about how to plan a YAHCS project, administer the survey via mail or
telephone, and score and report the survey findings to multiple stakeholders.
Online Resource: For more information on CAHMI, go to: http://www.cahmi.org
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Child Measures
Included
The YAHCS assesses the following aspects
of preventive care:
- Preventive screening
and counseling on risky behaviors.
- Preventive screening
and counseling on sexual activity and sexually transmitted diseases
(STDs).
- Preventive screening
and counseling on weight, healthy diet, and exercise.
- Preventive screening
and counseling on emotional health and relationship issues.
- Private and confidential
care.
- Helpfulness of counseling.
- Communication and experience
of care.
- Health information.
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Users
The YAHCS has been used to assess health care quality at
the national, State, geographic, county, and health plan level. The
following entities have used the YAHCS:
- Five health plans—CIGNA HealthCare (Southern California
Branch), Blue Cross Blue Shield of the Rochester Area, Kaiser Permanente
Medical Group, San Francisco Health Plan, and United Health Plan—and
one professional review organization, the Institute for Child Health
Policy, which used YAHCS as part of their Florida KidCare Evaluation
efforts.
- Washington State Department of Health: to assess the quality of
care provided to adolescents enrolled in Medicaid in Snohomish County.
- The FACCT Young Adult Online Survey about health and health care,
funded by the Robert Wood Johnson Foundation, used components of the
YAHCS.
- New York State Department of Health: to pilot the YAHCS for assessing
quality of care in five selected health plans.
- Two projects within the Child Health Insurance Research Initiative (CHIRI™) are using components of the YAHCS survey.
Online Resources:
Examples of reports generated from these field trials
and PowerPoint® presentations that highlight key findings from these
applications can be found on
the CAHMI Web site. Go to: http://www.cahmi.org
For more information on CHIRI™, go to: http://www.ahrq.gov/chiri/
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Comparisons
and Trends
The YAHCS results can be used for statistically
significant comparisons among plans, programs, and health care providers.
They can be used for trending over time, provided that the same or comparable
populations are being surveyed and that the same mode of administration
is used.
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Benchmarking
and Databases
CAHMI has worked collaboratively with
all users of the YAHCS and has maintained data related to these applications.
However, currently no benchmarking data are publicly available that
allow users to compare their findings with those of other users.
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Service Delivery
and Units of Analysis
YAHCS data can be collected and analyzed
at the following levels of analysis:
- National.
- State.
- County or other geographic
region.
- Health plan.
- By teen health, health
care, and sociodemographic characteristics.
Results of the YAHCS can be used to
report eight composite measures assessing domains of preventive and
developmental health care recommended for young adults:
- Preventive screening
and counseling on risky behaviors.
- Preventive screening
and counseling on sexual activity and STDs.
- Preventive screening
and counseling on weight, healthy diet, and exercise.
- Preventive screening
and counseling on emotional health and relationship issues.
- Private and confidential
care.
- Helpfulness of counseling.
- Communication and experience
of care.
- Health information.
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Length-of-Enrollment
Requirements
The length-of-enrollment requirement depends on the
purpose of the YAHCS implementation and the place of administration.
Only young adults who are 14 years or older should receive the survey.
For health plan assessments, however:
- Medicaid managed care
beneficiaries must be enrolled at least 6 months, with a break of no
more than 30 days.
- Commercial (employer-based)
plan members must be enrolled at least 12 months, with a break of no
more than 45 days.
These rules generally apply for other
assessment and tracking purposes.
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Data Issues
The YAHCS can be administered by:
- Mail.
- Telephone.
- Internet.
The forthcoming Guidelines for Implementing the
Young Adult Heath Care Survey will provide detailed information
about how to plan a YAHCS project, administer the survey via mail or
telephone, and score and report the survey findings to multiple stakeholders.
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Sample Sizes
The Guidelines for Implementing the Young Adult
Health Care Survey, available on the CAHMI Web site in July 2004,
will provide detailed information about the sample sizes needed for
specific applications of the YAHCS.
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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 YAHCS 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 YAHCS. Focus groups were
held with families and teens to identify the aspects of health care
quality that are important to parents and teens in the area of preventive
care. A review of the literature was conducted and relevant materials
were considered, including seminal work by Jon Klein, M.D., and John Santelli,
M.D., validating teen self-report about health care services received.
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.
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 YAHCS.
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Criteria
Used
The following criteria were used to
select topics assessed in the YAHCS:
- Appropriateness for young adults
14-18 years and older.
- Strength of scientific evidence.
- Professional consensus.
- Lack of more reliable, valid, or efficient way
to measure the topic.
- Importance of topic to young adults and parents
as ascertained from cognitive interviews and focus groups.
- Ease with which the topic can be validly and
reliably reported by parents.
- Parsimony (e.g., topic is not already largely
represented by another, related topic in the YAHCS).
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More Information
and User Support
Online Resources:
More information about the development process and
the initial pilot can be found on CAHMI's Web site and in "Assessing
health system provision of adolescent preventive services: the Young
Adult Health Care Survey," by Christina Bethell, Jonathan D. Klein, and Colleen Peck, published in Medical Care 2001 May;39(5):478-90.
Abstract available on PubMed®:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11317096&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-PHDS
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): Young Adult Health Care Survey (YAHCS). August 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/chtoolbx/measure7.htm
540 Gaither Road Rockville, MD 20850