Designing population health measures for kids
Measuring population health outcomes is still an early and evolving practice for health systems, payers and researchers. This is particularly so for pediatric populations. The majority of published outcomes measures are designed for adult populations, and measure conditions that typically present during adult years. These measures are often irrelevant to pediatric populations or reflect only small subsets of pediatric populations (e.g., children with chronic disease).
Existing pediatric outcomes measures are more often a proxy for assessing outcomes, focusing on actions and functions that are within the purview of a care delivery system. For example, the NCQA Core measures for pediatrics largely represent measures of utilization (e.g. emergency department visits) or care delivery processes (e.g. developmental screening in the first three years of life). With the exception of the measure for low-birth weight deliveries, there are no measures that assess health outcomes (e.g. prevalence of children 0-3 with age-appropriate development).
Measures of utilization and adherence to processes are important population health statistics. In most cases, however, they are insufficient to measure whether quality improvement efforts or care delivery practices generate meaningful improvements in health outcomes. A combination of leading and lagging measures yields the clearest picture of the health of a population.
Measures from sources such as those listed below, may reflect more meaningful outcomes of interest to patients and providers.
Annie E. Casey Foundation, Kids Count Measures: This annual report assesses the well-being of children in the U.S. using multiple child-level indicators across four domains: Economic Well-being, Education, Health, and Family & Community. Each domain measure is a composite of several sub-measures which reflect the influence of social determinants on health. Data sources for measures are varied including U.S. Census Bureau, Department of Education, Centers for Disease Control and Prevention, and Substance Abuse and Mental Health Services Administration. Measures such as 4th grade reading achievement levels, low birth weight babies, and teens ages 12 to 17, who abused alcohol or drugs in the past year, represent mid- and long-term outcomes with known implications on healthcare cost.
National Health Interview Survey: For more than 50 years, the National Health Interview Survey (NHIS) conducted by the National Center for Health Statistics, has been instrumental in tracking health care access and health status of the U.S. population. Table C-5 of the survey provides information on respondent-assessed health status for children under age 18 years (excellent, very good, good, fair or poor). This measure is used to calculate the percent of children in the US reporting excellent, very good, good, fair or poor health in the prior year. While subjective in nature, self-reports of health status are a meaningful outcome for patients and providers alike.
PROMIS® (Patient-Reported Outcomes Measurement Information System) is a set of highly reliable, person-centered measures that evaluates and monitors physical, mental, and social health in adults and children.
PedsQLTM is a validated, proprietary measurement tool for assessing Health-Related Quality of Life (HRQL) in healthy children and children with chronic conditions. The tool meaningfully assesses core dimensions of health in addition to role functioning for child and adolescent populations. The tool must be purchased for use.