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Improving the Quality of Care Delivered to Children Served by State Agencies

Workshop Brief for State and Local Policymakers

This workshop was designed for policymakers in the legislative and executive branches of State and local governments who are interested in children's health, especially those who manage publicly funded programs that deliver health care to children. The workshop was held in New Orleans, LA, January 24-26, 2001.

About the Workshop Sponsor.



The objectives for participants in this workshop included developing a better ability to:

  • Use defined measures to identify areas that need improvement, set priorities, and plan the most effective means for achieving improvement.
  • Identify and select appropriate measures for specific tasks.
  • Describe the benefits to each agency when multiple agencies coordinate activities.
  • Design strategies that facilitate change for State agencies, managed care organizations (MCOs), providers, and consumers.
  • Understand the barriers to effective collaboration and identify strategies for addressing them.

Session Summaries


Ensuring quality of care for children is a national, State, and local priority. Policymakers and others must work together to implement effective strategies to improve care. Measuring the performance of the health care system is critical to gauging the success of these improvement strategies.

Scope of Children's Health Problems

Children in the United States are experiencing epidemics in asthma, obesity, diabetes, and certain mental health conditions. As purchasers and regulators, States have a powerful ability to address these epidemics and improve the health of children. State agencies must work together to choose the issues they will address and the interventions they will implement to achieve the greatest improvement.

Child Health Toolbox

The Child Health Toolbox is a downloadable, online resource to help policymakers understand and use performance measurement. The Toolbox includes information on widely used measures and guidance for choosing the measures best suited to a program's goals.

Quality Improvement Cooperation

Two Massachusetts departments collaborated to develop multiple projects related to their efforts to improve the quality of care for children. Two examples of this cooperation are performance measures now used for Title V block grants and Medicaid-contracted MCOs, and strategies to improve childhood immunization rates.

Motivating Organizational Change

Effectively motivating and managing change involves a coordinated, multifaceted approach, including effective communication, collaborative experimentation, selecting target populations, and using measurement and feedback to communicate and adapt.

Coordinated Initiatives Improve Care

Several States have initiated multi-agency efforts to improve the quality of care provided to children.

  • Rhode Island departments created a system to compare health outcomes for Medicaid beneficiaries against individuals with private insurance or no insurance; an initiative to improve access and quality of care for children with special health care needs enrolled in Medicaid; and an integrated system for foster children.
  • Missouri departments created a system of health status indicators for MCO performance.
  • The Alabama Governor's Task Force on Children's Health Insurance involves seven State agencies.

Changing Care Delivery

Clinical practices are influenced by many factors; some may impede the quality of care delivered. Actions that policymakers can take to facilitate clinical practice change include:

  • Form guiding coalitions and engage clinical leadership.
  • Use measurement for motivation and improvement.
  • Undertake collaborative improvement.

Changing Consumer Thinking

Social marketing can be used to change risky behavior, improve services, or build social capital. Social marketing involves listening to target populations to learn their wants and needs, then determining how to beat the "competition" to reach that population.

Putting Theory into Practice

A series of simulation exercises completed by small groups of participants formed an integral piece of this hands-on workshop. Groups were composed of representatives from multiple State and local agencies.

AHRQ's User Liaison Program (ULP) disseminates health services research findings in easily understandable and usable formats through interactive workshops. Workshops and other support are planned to meet the needs of Federal, State, and local policymakers, and other health services research users, such as purchasers, administrators, and health plans.

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