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Quality of Health Care for Children and Adolescents: a Chartbook

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Quality of Health Care for Children and Adolescents: a Chartbook ChildChartbook-Cover-D3c.qxd 2/23/04 10:57 AM Page 1 Quality of Health Care for Children and Adolescents: A Chartbook SHEILA LEATHERMAN | DOUGLAS MCCARTHY UNC PROGRAM ON HEALTH OUTCOMES THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL The Commonwealth Fund One East 75th Street New York, NY 10021-2692 Telephone 212.606.3800 Facsimile 212.606.3500 Email [email protected] Web www.cmwf.org APRIL 2004 p1-CalloutForPDF.qxd 3/22/04 12:42 PM Page 1 Quality of Health Care for Children and Adolescents: A Chartbook SHEILA LEATHERMAN | DOUGLAS MCCARTHY UNC PROGRAM ON HEALTH OUTCOMES THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL We'd like to know what you think about this chartbook. To take a short, anonymous user survey, click on the following link or copy the address into your Web browser: http://64.73.28.22/s.asp?u=50446418798. Or, e-mail [email protected] to receive an invitation to take the survey. You can also view and download the chartbook through the Commonwealth Fund Web site (www.cmwf.org). Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and should not be attributed to The University of North Carolina or The Commonwealth Fund or its directors, officers, or staff. APRIL 2004 ChildChartbook-p1to30.qxd 3/22/04 10:04 AM Page 2 Authors Sheila Leatherman Research Professor, School of Public Health, and Senior Investigator, UNC Program on Health Outcomes, The University of North Carolina at Chapel Hill; and Senior Associate, Judge Institute, University of Cambridge, England Douglas McCarthy President, Issues Research, Inc., Durango, Colo. (under contract to The University of North Carolina at Chapel Hill) Pediatric Expert Consultants Charles Homer, M.D., M.P.H. President and CEO, National Initiative for Children’s Healthcare Quality, Boston, Mass. Mark Schuster, M.D., Ph.D. Associate Professor of Pediatrics and Health Services, UCLA Schools of Medicine and Public Health; Senior Natural Scientist, RAND, Santa Monica, Calif.; and Director of the UCLA/RAND Center for Adolescent Health Promotion Editorial and Scientific Consultants Kathleen Lohr, Ph.D. Research Professor, School of Public Health, and Senior Investigator, UNC Program on Health Outcomes, The University of North Carolina at Chapel Hill; and Distinguished Fellow, RTI International Joanne Garrett, Ph.D. Professor, Department of Medicine, The University of North Carolina at Chapel Hill Advisory Board Anne-Marie Audet, M.D., M.Sc. Assistant Vice President, The Commonwealth Fund, New York, N.Y. Donald Berwick, M.D., M.P.P. President and CEO, Institute for Healthcare Improvement, Boston, Mass. Robert Galvin, M.D. Director, Global Health Care, General Electric Company, Fairfield, Conn. Judith Hibbard, Dr.P.H. Professor, Department of Planning, Public Policy, and Management, University of Oregon, Eugene Elizabeth McGlynn, Ph.D. Associate Director, RAND Health, Santa Monica, Calif. William Roper, M.D., M.P.H. Dean, School of Public Health, The University of North Carolina at Chapel Hill Project Administration Sue Tolleson-Rinehart, Ph.D. Administrator, UNC Program on Health Outcomes, The University of North Carolina at Chapel Hill Sara Massie Research Assistant, UNC Program on Health Outcomes, The University of North Carolina at Chapel Hill Design Jim Walden Walden Creative, LLC, Bayfield, Colo. ChildChartbook-Front-D3g.qxd 2/26/04 8:32 AM Page 3 Table of Contents Acknowledgments • page 4 Summary of Charts and Findings • page 5 Introduction and Overview • page 15 The quality of children’s health care today • page 15 Defining quality of health care for children • page 17 Challenges and considerations in measuring quality of health care for children • page 19 A systems approach to improving quality of health care for children • page 21 Conclusion • page 24 Methods and Organization of the Chartbook • page 25 Development process • page 25 The conceptual framework for reporting on quality of health care • page 26 Scientific issues and terminology • page 29 Charts • page 31 Section 1. Effectiveness • page 32 Section 2. Patient Safety • page 52 Section 3. Access and Timeliness • page 58 Section 4. Patient and Family Centeredness • page 74 Section 5. Disparities • page 80 Section 6. Capacity to Improve • page 92 Technical Appendix • page 111 References • page 119 About the Authors • page 132 Leatherman and McCarthy, Quality of Health Care for Children and Adolescents: A Chartbook, 2004. The Commonwealth Fund 3 ChildChartbook-Front-D3g.qxd 2/26/04 8:32 AM Page 4 Leatherman and McCarthy, Quality of Health Care for Children and Adolescents: A Chartbook, 2004. The Commonwealth Fund 4 Acknowledgments This chartbook is a compendium of data representing the efforts of many Voices; Timothy Whitmire, Ph.D., North Carolina Department of Health and researchers, to whom we are indebted for their contributions. We especially wish Human Services; Joanne Wolfe, M.D., M.P.H., Dana-Farber Cancer Institute and to thank the individuals who kindly provided data, sources, clarification, or Children's Hospital Boston. We regret that, due to space limitations, we were advice: Magaly Angeloni, Rhode Island Department of Health; Anne Beal, M.D., unable to include all the information that was provided us. M.P.H., The Commonwealth Fund; Christina Bethell, Ph.D., Foundation for We thank the staff at The Commonwealth Fund and especially Anne-Marie Audet, Accountability; Stephen Blumberg, Ph.D., Centers for Disease Control and M.D., M.Sc., and Stephen Schoenbaum, M.D., M.P.H., for their advice and support, Prevention; Monica Brooks and Leslie Hazle, M.S., R.N., C.P.N., Cystic Fibrosis and Bill Silberg and the communications team. We also thank The University of Foundation; John Patrick Co, M.D., M.P.H., Harvard Medical School; Diane North Carolina School of Public Health for institutional support of this project, and Cousins, R.Ph., and Rodney Hicks, R.N., M.S.N., U.S. Pharmacopeia; Missy the staff of the UNC Program on Health Outcomes for their untiring assistance. Fleming, Ph.D., American Medical Association; Jeffrey Geppert, M.A., National Bureau of Economic Research; Mary Margaret Gottesman, Ph.D., R.N., C.P.N.P., We gratefully acknowledge the consultants and advisory board members, whose National Association of Pediatric Nurse Practitioners; Margaret Grey, Dr.P.H., names are listed on the credits page, as well as the following reviewers, who Yale University; Sheryl Kataoka, M.D., M.S.H.S., University of California, Los kindly provided comments and advice to help improve the chartbook. Angeles; Howard Kilbride, M.D., Children’s Mercy Hospital; Michael Konstan, M.D., Case Western Reserve University; Sharon Lau, M.S., Medical Management Denise Dougherty, Ph.D., Senior Advisor, Child Health, Planning, Inc.; Tracy Lieu, M.D., M.P.H., Harvard Medical School; Jun Ma, M.D., Agency for Healthcare Research and Quality R.D., Ph.D., and Kathryn McDonald, M.M., Stanford University; Merle Bernard Guyer, M.D., M.P.H., Zanvyl Kreiger Professor and Chair, McPherson, M.D., M.P.H., Michael Kogan, Ph.D., and Stella Yu, Sc.D., M.P.H., Department of Population and Family Health Sciences, Maternal and Child Health Bureau; Russell Mardon, Ph.D., and Eric Szaal, Johns Hopkins Bloomberg School of Public Health NCQA; Paul Miles, M.D., American Board of Pediatrics; Cynthia Minkovitz, Jonathan Klein, M.D., M.P.H., Professor, Department of Pediatrics, and M.D., M.P.P., Johns Hopkins University; James Perrin, M.D., Harvard Medical Division of Adolescent Medicine, Strong Children’s Research Center, School; Jenna Rabideaux, Health Research and Educational Trust; Denise Remus, University of Rochester School of Medicine Ph.D., R.N., and Anne Elixhauser, Ph.D., Agency for Healthcare Research and Edward Schor, M.D., Assistant Vice President, The Commonwealth Fund Quality; Patrick Romano, M.D., M.P.H., University of California, Davis; Ellen Barbara Starfield, M.D., M.P.H., University Distinguished Service Professor, Schwalenstocker, National Association of Children’s Hospitals and Related Johns Hopkins Bloomberg School of Public Health Institutions; Lisa Simpson, M.B., B.Ch., M.P.H., University of South Florida; The authors retain sole responsibility for any errors or omissions in the content Anthony Slonim, M.D., M.P.H., Children’s National Medical Center; Michael of the chartbook. Steinman, M.D., Veterans Affairs Medical Center, San Francisco; Patrick Vivier, M.D., Ph.D., Brown University; Robert Weech-Maldonado, Ph.D., The Cover photography: Roger Carr (top left, top right); Pennsylvania State University; Nora Wells, M.S.Ed., and Connie Sun, Family Lynn Johnson (bottom left); Bill Gallery (bottom right) ChildChartbook-Front-D3g.qxd 2/26/04 8:32 AM Page 5 Summary of Charts and Findings CHART/TOPIC DEVELOP. STAGE DATA SOURCE FINDINGS IMPLICATIONS PAGE EFFECTIVENESS: STAYING HEALTHY 1:1 Receipt of Early childhood to 1999 National Survey Nearly one-quarter (23%) of children Lack of regular preventive care 32 Recommended adolescence of America’s Families and adolescents did not have an annual represents missed opportunity for Preventive Health (3–17 years) (Yu et al. 2002) preventive health care visit at prevention, early detection, and Care Visits recommended ages. Adolescents were treatment of health and developmental less likely to have preventive care visits problems, and is associated with more ER than were younger children. visits and hospitalizations. 1:2 Immunizations for Early childhood 2002 National One-quarter (25%) of young children Unvaccinated children are vulnerable to 34 Young Children (19–35 months) Immunization Survey were not up to date on all recommended infectious disease outbreaks, resulting in (CDC 2003b) doses of five key vaccines nationally. missed school and work days for parents Among the states, this gap ranged from and additional doctor visits, hospitaliza- one of seven children (14%) in tions, and potential deaths. Massachusetts to more than one-third (37%) in Colorado.
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