Child and Adolescent Health and Health Care Quality Measuring What Matters (2011) / Chapter Skim
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4 Existing Measures of Child and Adolescent Health
4 Existing Measures of Child and Adolescent Health
Pages 91-134
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From page 91... ...
Likewise, data collection systems that monitor educational performance or children's well-being frequently omit health data. • Multiple recommendations for improving health measures for children and adolescents have emerged in recent years.
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From page 92... ...
. • A life-course approach provides a basis for understanding the relationships among early health conditions, health influences, and later health status.
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From page 93... ...
Practical issues include provider time, reimbursement, and differential skill requirements for administering the instruments. Early efforts focused specifically on measures of child health status that would capture issues related to functional abilities were patterned after more well-established adult measures (Eisen, 1980; Starfield et al., 1993)
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From page 94... ...
Such analyses might include the relationships among children's insurance status, their access to health providers, and their use of and the effectiveness of health care, as well as the relationship between child health status and family income, family stability and preservation, and children's school readiness and educational achievement and attainment. The measures would also make it possible to examine relationships between the health status of children and adolescents and their educational performance, their social behaviors, and their future health status and productivity as adults.
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From page 95... ...
focuses on the specific measures of child health included in selected national surveys (e.g., up-to-date immunizations or nutrition adequacy)
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From page 96... ...
. Three primary sources of data are used nationally to track morbidity and mortality: the National Vital Statistics System (NVSS)
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From page 97... ...
The NVSS relies on International Classification of Diseases (ICD) codes to describe health conditions, disorders, diseases, and injuries.
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From page 98... ...
. Strengths NVSS data provide a rigorous classification scheme for deaths associated with an array of health conditions, including pregnancy, abortions, and various types of injuries that are common among children and adolescents.
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From page 99... ...
And increasingly, they want to know whether children are on track to become healthy adults, especially those young people who display early signs of poor health conditions that are associated with adverse health outcomes and chronic disease in older populations. While NCHS can link vital statistics data with other data sources (including census data, Supplemental Nutrition Program for Women, Infants, and Children [WIC]
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From page 100... ...
, nor does it collect data on the types of health plans associated with selected health conditions or injuries. Hospital discharge data, of course, are limited in that they capture only those events that occur in a hospital.
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From page 101... ...
. Data collected through the NSCH support analyses of physical, emotional, and behavioral child health indicators, as well as contextual factors.
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From page 102... ...
population of children and adolescents, the survey does not adequately represent large numbers of disadvantaged children who may rely on Medicaid or CHIP health plans for their health services, nor does it include children or adolescents who reside in group homes or juvenile detention centers and who may be at greatest risk of poor health outcomes. For example, the sample is too small to document rates of chronic health conditions, such as sickle cell disease, that may be relatively rare in the general population but more common among certain racial and ethnic groups of children and adolescents.
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From page 103... ...
Preventable Common Health Conditions (Especially Mental and Behavioral Health and Oral Health) Apart from mortality and hospitalization data, as well as data on children with special needs and/or chronic health conditions, a number of population-based child health indicators are used as the basis for the early detection of health conditions that are likely to contribute to chronic conditions during either childhood or adulthood.
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From page 104... ...
These data provide important surveillance information that helps identify and address critical health problems. Major survey-based data collection efforts include the National Health and Nutrition Examination Survey (NHANES)
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From page 105... ...
They also provide insight into behavioral trends and health conditions that may evolve into significant health problems as these young people become adults. In contrast to population health surveys based on diagnosed conditions that fit within the ICD-9 categories, surveys of risk behaviors are designed to identify the behaviors or settings that may contribute to future health disorders as children and youth become adults.
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From page 106... ...
Limitations Surveys of risk behaviors involve more ambiguity and less precision than the collection of data on established conditions. Studies of sexual assault and intimate partner violence, for example, suggest that such experiences often are associated with emotional and mental disorders that are not detected until many years after the initial victimization experience.
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From page 107... ...
The NHANES also lacks the ability to measure important behavioral and mental health conditions (IOM and NRC, 2004)
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From page 108... ...
. • M ore than 60 percent of children with special health care needs have health conditions that affect their daily activities (FIFCFS, 2009)
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From page 109... ...
Ideally, functional status would include more complete descriptions of levels of functioning in a variety of settings and roles. The primary sources of data on functional status are the NS-CSHCN, the NHIS, the NHANES, and the National Longitudinal Study of Adolescent Health (Add Health)
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From page 110... ...
Therefore, these measures may be a poor estimate of their overall functioning. Existing measures of child functional status are time-consuming (Bayley, 1993; Sparrow et al., 2006)
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From page 111... ...
With the exception of the disease-specific scales, little has been done to correlate reports of functional limitations with clinical observations; virtually no predictive validity work has been done that could demonstrate how a measure of functional status at a particular point in time has implications for planning for later services; and it is difficult to reconcile specialized assessments (e.g., developmental milestones, behavior problems, autism symptoms) with general health status.
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From page 112... ...
Without such data and related measures, it is impossible to monitor progress in helping dying children gain the best possible quality of life. In 2004, the Nursing Home Survey added questions on advance directives and end-of-life care, and in 2009, the National Home and Hospice Care Survey added questions regarding end-of-life care.
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From page 113... ...
. The underrepresentation and omission of key groups of vulnerable children and adolescents have prompted the development of targeted surveys that focus on the health status of specific populations, such as children and adolescents in poor households, those served by child welfare agencies, and those in juvenile detention settings.
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From page 114... ...
Health conditions of children and adolescents from each of these four groups were compared with health conditions of white children and adolescents. The AAP committee organized its findings into nine areas: mortality rates, health status, adolescent health, chronic diseases (particularly asthma and mental health)
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From page 115... ...
. Health data from most national population surveys and administrative records include gender and racial/ethnic identifiers that support analyses of health disparities for these categories.
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From page 116... ...
Strengths One of the unique contributions of the SIPP is that, in addition to routinely collecting data on household earnings and employment, it collects data on household composition and medical expenses. Collectively, these data provide insights into disparities and social determinants of health.
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From page 117... ...
For example, the highest income category reported is often "$75,000 or higher"; $75,000 is not a high income level when it supports a family of four to six, a common family size. To understand the role of social factors in child health, one must be able to compare not just poor or low-income persons with everyone else (typically the only comparisons that can be made with most routine data sources)
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From page 118... ...
With respect to primary language, 14 states offer the choice of English, Spanish, and either "other" or specific other languages; however, 21 states have only a blank space in which applicants are to fill in their primary language. The nonstandard way in which race, ethnicity, and language data are collected in eligibility files hinders comparisons of data across states for purposes of monitoring disparities in service delivery (IOM, 2009d)
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From page 119... ...
For children and youth with serious emotional disorders, the Substance Abuse and Mental Health Services Administration funds the System of Care initiative to provide supportive settings for limited communities. This interest in assessing the impact of the physical environment, the health care delivery system, and social contexts on the current health status and healthy development of young people has generated several key studies aimed at linking specific childhood experiences, events, or relationships with selected health behaviors and health outcomes.
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From page 120... ...
A Life-Course Approach The life-course approach helps explain patterns of health and disease across populations and over time. Chapter 2 describes the growing recognition of the ways in which health influences occurring during early childhood -- and even interactions with maternal health during the prenatal and preconception stages -- lay the foundation for health throughout the lives of children, adolescents, and adults (Ben-Shlomo and Kuh, 2002; Halfon and Hochstein, 2002; Kuh and Ben-Shlomo, 1997)
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From page 121... ...
In addition to life-course indicators, interest has grown in looking beyond the measurement of specific health conditions to focus on positive states of health, wellness, functioning, and health potential during important transition periods, especially early childhood and adolescence. Attention is increasingly being paid to the importance of monitoring the presence of healthy behaviors, such as adequate sleep, good dietary habits, and physical activity.
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From page 122... ...
Such measures are not commonly viewed as health measures, but they are included in several child and adolescent health surveys and provide indicators of the functional or developmental status of general and selected populations of children and youth. Currently, the concept of indicators of positive states of health, functioning, and development is relatively new, and a coherent set of priority indicators in these areas is lacking.
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From page 123... ...
The survey collects data on health risk behaviors, preventive health practices, and health care access. It is used by all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S.
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From page 124... ...
Box 4-2 includes examples of accessible data sets across the seven priority areas for child and adolescent health that can be used by families, researchers, insurers, policy makers, and advocates to assess the health and mortality experiences of children and adolescents. These include public data sets, aggregations and syntheses of public data (see the next section)
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From page 125... ...
In the absence of population or administrative data sources that can link specific experiences or events to selected health behaviors in individual children, many researchers rely on linking selected data sources at the geographic level -- for example, census tracts, counties, or states. Typically they link one of the individual-level data sources discussed above with another data source describing the social contexts of children and youth as proxy measures for adverse or supportive environments in a child's census tract, county, or state.
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From page 126... ...
. • ATA2010 is an interactive database system developed by staff of the Division D of Health Promotion Statistics at the National Center for Health Statistics, and contains the most recent monitoring data for tracking Healthy People 2010.
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From page 127... ...
civilian noninstitutionalized population. However, none of the Child Health and Preventive Care section variables are available on MEPSnet/HC (http:// www.meps.ahrq.gov/mepsweb/data_stats/MEPSnetHC.jsp)
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Child Health USA (Health Resources and Services Administration/ Maternal and Child Health Bureau) Child Trends DataBank (Child Trends)
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From page 129... ...
One of the 28 focus areas is maternal, infant, and child health, and 107 of the objectives pertain to adolescents and young adults. The two overarching goals of Healthy People, which are applicable across the life course, are to increase quality of life and years of healthy life and eliminate health disparities.
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From page 130... ...
Bethell (2010) has identified four key questions to be considered in aligning population health indicators with efforts to improve the quality of health care services for children and youth: • S hould the emphasis be on leading causes of death and most com mon reasons for using medical care or on the prevalence of ongo ing health conditions (also described as the low-volume/high-cost versus high-volume/low-cost trade-off)
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From page 131... ...
131 EXISTING MEASURES OF CHILD AND ADOLESCENT HEALTH FIGURE 4-1 County Health Rankings model. SOURCE: Booske and UWPHI, 2010.
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From page 132... ...
• M ost child and adolescent health data sets lack the capacity to support efforts to track the life-course implications of child health events, especially those that occur in early stages of development. The committee has identified seven priority areas for future measures that could provide relevant information on the health of children and adolescents for policy makers, service providers, and the general public and also inform quality improvement efforts within public and private health plans.
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From page 133... ...
. Finally, the seven priority areas, as well as a life-course perspective, should be used to direct analysis toward possible emerging threats to child health as a test of how comprehensive and useful this taxonomy can be in generating priority indicators for child and adolescent health.
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