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



Wendy Wolf, M.D., M.P.H., Senior Advisor, Office of the Administrator, Agency for Healthcare Research and Quality (AHRQ) and Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services, Rockville, MD.

Children require a different health care focus—and quality measures—than adults. Factors differentiating children's care include:

  • Developmental changes modify children's health care use as they age. Children also have greater use of preventive services and distinct provider systems.
  • Dependency on adults to obtain health care.
  • Demographic patterns, including greater reliance on public insurance and public health systems, leading to interplay between different systems each with separate funding streams for health care and other services.
  • Differential epidemiology, including relative rarity of chronic diseases.

Ensuring quality of care for children is a national, State, and local priority. Although quality assurance measures have come a long way, there is much more work to be done. Multi-entity collaboration in implementing improvement strategies, as well as in acquiring, analyzing, and evaluating data will improve efficiency, efficacy, and cost.

Quality measures should improve child health by:

  • Identifying gaps and reducing variability in performance.
  • Guiding improvements through evidence-based interventions.
  • Increasing effectiveness and efficiency by decreasing underuse, overuse, and misuse.
  • Improving child and family satisfaction.
  • Evaluating new policies.
  • Insuring accountability.

Strategies to improve care move beyond tools and measurements:

  • Assess needs of families and children.
  • Define data sources and capabilities.
  • Select assessment methods that inform multiple stakeholders.
  • Review tools and determine how data will be used to assess performance.
  • Choose among the options.
  • Determine how data will guide quality improvement.

AHRQ can assist States and localities through:

  • Child health service research (e.g., Evidence-based Practice Centers).
  • Tools such as the Consumer Assessment of Health Plans (CAHPS®), National Guideline Clearinghouse™, Health Cost and Utilization Project (HCUP), and Medical Expenditure Panel Survey (MEPS).
  • Improved communication between participants (e.g., research networks and Web maps showing AHRQ researchers and research projects).


Ferris TG, Dougherty D, Blumenthal D, et al. A Report Card on Quality Improvement for Children's Health Care. Pediatr 2001, Jan; 107(1):143-55.

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