Assessing the Quality of Care for Children

Although considerable work has been done in developing methods and tools for assessing quality of care for adults, less work has been done on children's health care. This article discusses the quality of care delivered to children. Although federal health care reform legislation has not been enacted, efforts continue to reduce costs, increase access, and improve quality. This first article suggests several methodological strategies for assessing quality of care for children, including aggregating across services for several conditions, examining access and appropriateness of care, developing generic measures of children's health status sufficiently sensitive to distinguish sick from well children and among levels of severity, and linking outcome measures and variations in process. If publicly accountable measures are to be developed to assess quality of care for children, especially in managed care plans, two possible methodological problems need to be addressed: playing to the measures (i.e., health plans emphasize the care they know is being monitored) and gaming (i.e., putting the best light on data collection by manipulating sample frames, denominators, and techniques of data gathering).