Developing and Analyzing Performace Measures. A Guide for Assessing Quality of Care for Children with Special Health Care Needs

摘要

Quality assurance, the collection of relevant data for monitoring health outcomes and access to care and for identifying vulnerable populations and gaps in services, has become more critical to the survival of programs that serve children with special health care needs (CSHCN). State CSHCN programs are in transition from providing direct services to promoting and monitoring comprehensive systems of care. Recent changes in health care financing have led to an increase in the number of CSHCN entering managed care plans, placing them at risk if treatment is not appropriate or specialty care is not provided. Ideally, managed care health systems improve access to health care for all persons, assure the quality of care provided, and produce cost savings. Effective and ongoing mechanisms for quality assurance are key to assuring that managed care systems reach, appropriately serve, and improve the health of CSHCN. Measures of service delivery for CSHCN under managed care must be integrated with appropriate population-based health status and health outcome indicators, resulting in a uniform set of data that allows both public officials and consumers to evaluate and compare system performance.