Bethell C, Read D, Fowler J, Wells N, Thompson J, Newacheck P; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 65.
FACCT--The Foundation for Accountability, 520 SW 6th Avenue, Suite 700, Portland, Oregon 97204, Phone: (503) 223-2228, Fax: (503) 223-4336, E-mail: cbethell@facct.org
RESEARCH OBJECTIVE: To specify a meaningful, valid, efficient, and feasible approach to measuring health care quality for children with special health care needs (CSHCN) for purposes of comparing the performance of managed care health plans.STUDY DESIGN: A family survey-based measurement methodology was developed through a national collaborative process involving consumers, experts, providers and policymakers. Parents of CSHCN were additionally involved through focus groups and cognitive interviews regarding the design and administration of the family survey. The methodology includes a family survey integrated into the widely used Consumer Assessment of Health Plans Survey (CAHPS) and a standardized sampling and screening approach for identifying a robust and valid sample of CSHCN. Feasibility was evaluated in terms of data availability, deployment costs and sufficiency of the sample of CSHCN identified. The relevance of the twelve new quality measures derived for purposes of comparing quality was evaluated by testing hypotheses regarding variations in quality of care scores among health plans and between children with and without special health care needs within health plans. The reliability and convergent and divergent validity of the CSHCN quality measures was also examined.POPULATION STUDIED: Medicaid clients enrolled in managed care health plans representing both the Temporary Aid to Needy Families and Supplemental Security Income eligibility groups. (N = 20,000).PRINCIPAL FINDINGS: Building off the existing CAHPS survey, the new cost for administration of the CSHCN family survey was minimized. New work to identify the survey sample required the use of administrative data and took 3-6 days of effort by managed care organizations when done for the first time. An average of 40% of children were identified as CSHCN by the survey based screener using the enriched sampling methodology (compared to the 18-20% expected without this method), allowing for the construction of robust quality measures for this population and a significantly reduced starting sample size. The family survey yielded twelve consumer relevant quality indicators regarding access to care and specialized services, communication with providers, getting needed information, family participation, coordination of care and overall ratings of health plans and providers who care for CSHCN. Variations among health plans and within health plans between children with and without special health care needs were consistently observed for mostindicators. The CSHCN measures received approval by the National Committee on Quality Assurance for inclusion in the Health Employer Data and Information Set in 2002 (pending final review).CONCLUSIONS: The CSHCN quality measurement method is a feasible and efficient approach for evaluating health care quality compared to other potential methods. The measures discriminate among health plans and between children with and without special health care needs and are useful for comparing performance as well as for stimulating quality improvement within health plans.IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: Consumers, public and private purchasers of care and managed care organizations share a pressing need to evaluate quality of care for CSHCN. The method developed and tested in this study has application for this purpose and has the advantage of examining quality for a broad group of CSHCN rather than only those children meeting SSI, functional disability or diagnosis criterion.PRIMARY FUNDING SOURCE: The David and Lucile Packard Foundation, The Agency for Healthcare Research and Quality
Publication Types:
Keywords:
- Child
- Child Health Services
- Data Collection
- Health Planning
- Health Services Needs and Demand
- Humans
- Insurance, Health
- Interviews as Topic
- Managed Care Programs
- Medicaid
- Needs Assessment
- Quality of Health Care
- Research Design
- economics
- methods
- hsrmtgs
Other ID:
UI: 102273274
From Meeting Abstracts