Methodologic challenges in developing and implementing measures of quality for child health care.
OBJECTIVE
To review the major building blocks in measurement of quality for child health care, with recommendations for future research.


METHODS
We describe a framework of building blocks for quality measurement and discuss how an investigator's choices for each component are constrained by the special features of child health care.


RESULTS
Methodologic challenges for children's health care include developmental change and dependency on others, fragmentary care and inadequate health care data, unusual care settings, potential for long-term consequences, proxy reporting of outcomes and patient experience, small sample sizes, and lack of evidence that links processes and outcomes of care and of methods for risk adjustment. We cite examples of child-specific measures of quality that illustrate solutions to these challenges.


CONCLUSIONS
Children are different from adults, and measures of health care quality for children must differ from those for adults. We suggest future research on measures of quality directed toward overcoming the methodologic problems specific to child health care.
Palmer
R H
RH
Center for Quality of Care Research and Education and Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA. qcare@hsph.harvard.edu
Miller
M R
MR
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration / Q000592:standards*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration / Q000592:standards*; D002675:Child, Preschool; D005260:Female; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D016730:Program Development; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods*; D014481:United States