title: Child and adolescent health care quality and disparities: are we making progress?
abstract: OBJECTIVE
  Children and adolescents are known to experience poor health care quality; some groups of children have poorer health care than others. We sought to examine trends over time in health care quality and disparities by race, Hispanic ethnicity, income, insurance, gender, rurality, and special health care needs.
  
  
  METHODS
  Source data were extracted from the 2011 National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) database, which contains aggregated data from many government and private sources for the years 2000 through 2009. The NHQR and NHDR approaches to calculating disparities and trends in quality and disparities were used. Within each quality measure with available data, results for demographic subgroups of children characterized by race/ethnicity, income, insurance, residence, special health care need, and gender were compared to those of a reference group to determine whether disparities existed and whether disparities had changed over time.
  
  
  RESULTS
  Of 68 measures with data for calculating potential disparities, 50 showed disparities in quality for at least 1 comparison subgroup in the most recent year of data available, while 18 measures showed no such disparities. Of the 50 measures with current disparities, 39 measures had sufficient data to calculate trends. Among the 137 comparisons made within these 39 measures, there was no change in disparities over time for 126 comparisons, 3 comparisons worsened, and 8 comparisons improved.
  
  
  CONCLUSIONS
  There was some progress in health care quality and reducing disparities in children's health care quality from 2000 to 2009; opportunities for targeting improvement strategies remain.
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, Md. Electronic address: denise.dougherty@ahrq.hhs.gov.
authors.forename: Denise
authors.initials: D
authors.lastname: Dougherty
authors.affiliation: Social and Scientific Systems Inc, Silver Spring, Md.
authors.forename: Xiuhua
authors.initials: X
authors.lastname: Chen
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, Md.
authors.forename: Darryl T
authors.initials: DT
authors.lastname: Gray
authors.affiliation: National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards / Q000639:trends*; D001249:Asthma / Q000628:therapy; D002648:Child; D002662:Child Health Services / Q000592:standards / Q000639:trends*; D002675:Child, Preschool; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology / Q000639:trends*; D006630:Hispanic or Latino; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D058996:Quality Improvement / Q000706:statistics & numerical data / Q000639:trends*; D011787:Quality of Health Care / Q000592:standards / Q000639:trends*; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States
keywords: Children's Health Insurance Program (CHIP); Hispanic; Medicaid; asthma; disparities; patient centeredness; preventive services; quality; trends