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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.

      Keywords

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      References

      1. US Department of Health and Human Services. National strategy for quality improvement in health care. Available at: http://www.ahrq.gov/workingforquality/. Accessed December 12, 2013.

      2. US Department of Health and Human Services. HHS action plan to reduce racial and ethnic health disparities. Available at: http://www.hhs.gov/news/press/2011pres/04/04hdplan04082011.html. Accessed December 12, 2013.

      3. Children’s Health Insurance Program Reauthorization Act of 2009. Public Law 111–113. Available at: http://www.gpo.gov/fdsys/pkg/PLAW-111publ3/pdf/PLAW-111publ3.pdf. Accessed December 12, 2013.

      4. Agency for Healthcare Research and Quality. Children’s health insurance program reauthorization act. Available at: http://www.ahrq.gov/policymakers/chipra/index.html. Accessed December 12, 2013.

      5. Agency for Healthcare Research and Quality. 2011 national healthcare quality and disparities reports. Available at: http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr11/qrdr11.html. Accessed August 9, 2013.

        • Clancy C.
        The quality improvement marathon: slow pace for overall improvement while access remains far behind.
        Am J Med Qual. 2011; 26: 405-407
        • Leatherman S.
        • McCarthy D.
        Quality of Health Care for Children and Adolescents: A Chartbook.
        The Commonwealth Fund, New York, NY2004
        • Flores G.
        • Tomany-Korman S.
        Racial and ethnic disparities in medical and dental health, access to care, and use of services in US children.
        Pediatrics. 2008; 121: e286-e298
        • Bethell C.
        • Kogan M.
        • Strickland B.
        • et al.
        A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations.
        Acad Pediatr. 2011; 11: S22-S33
        • Berdahl T.
        • Friedman B.
        • McCormick M.
        • Simpson L.
        Annual report on health care for children and youth in the United States: trends in racial/ethnic, income, and insurance disparities over time, 2002–2009.
        Acad Pediatr. 2013; 13: 191-203
      6. Institute of Medicine. Child and adolescent health and health care quality: measuring what matters. Available at: http://www.iom.edu/reports/2011/child-and-adolescent-health-and-health-care-quality.aspx. Accessed August 9, 2013.

        • Marin M.
        • Zhang J.
        • Seward J.
        Near elimination of varicella deaths in the US after implementation of the vaccination program.
        Pediatrics. 2011; 128: 214-220
        • Patzer R.
        • Sayed B.
        • Kutner N.
        • et al.
        Racial and ethnic differences in pediatric access to preemptive kidney transplantation in the United States.
        Am J Transplant. 2013; 13: 1769-1781
        • Brilli R.
        • McClead R.J.
        • Crandall W.
        • et al.
        A comprehensive patient safety program can significantly reduce preventable harm, associated costs, and hospital mortality.
        J Pediatr. 2013; 163: 1638-1645
        • Fiks A.
        • Mayne S.
        • Localio A.
        • et al.
        Shared decision-making and health care expenditures among children with special health care needs.
        Pediatrics. 2012; 129: 99-107
        • Fiks A.
        • Mayne S.
        • Localio A.
        • et al.
        Shared decision making and behavioral impairment: a national study among children with special health care needs.
        BMC Pediatr. 2012; 12
      7. National Business Group on Health. Investing in Maternal and Child Health. Washington, DC: National Business Group on Health.

      8. Heckman J. Return on investment: cost vs benefits. Available at: http://www.childandfamilypolicy.duke.edu/pdfs/10yranniversary_Heckmanhandout.pdf. Accessed August 9, 2013.

        • RAND Labor and Population
        Proven Benefits of Early Childhood Interventions.
        RAND, Santa Monica, Calif2005
        • Haas S.
        • Glymour M.
        • Berkman L.
        Childhood health and labor market inequality over the life course.
        J Health Soc Behav. 2011; 52
        • National Research Council and Institute of Medicine
        Children’s Health, the Nation’s Wealth—Assessing and Improving Child Health.
        National Academies of Science, Washington, DC2004
        • Halfon N.
        • Conway P.H.
        The opportunities and challenges of a lifelong health system.
        N Engl J Med. 2013; 368: 1569-1571
      9. Bengtson V, Allen K. The life course perspective applied to families over time. In: Sourcebook of Family Theories and Methods. 1993:469–504.

      10. US Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau. Rethinking MCH: the life course model as an organizing framework. Version 1.1: concept paper. November 2010. Available at: http://mchb.hrsa.gov/lifecourse/rethinkingmchlifecourse.pdf. Accessed December 11, 2013.

        • LaVeist T.
        • Gaskin D.
        • Richard P.
        Estimating the economic burden of racial health inequalities in the United States.
        Int J Health Serv. 2011; 41: 231-238
        • Daschle T.
        • Domenici P.
        • Frist W.
        • Rivlin A.
        Prescription for patient-centered care and cost containment.
        N Engl J Med. 2013; 369: 471-474
      11. 42USC. 299a–1(a)(6).

      12. Agency for Healthcare Research and Quality. National Healthcare Disparities Report, 2012. Available at: http://www.ahrq.gov/research/findings/nhqrdr/nhdr12/index.html. Accessed August 5, 2013.

      13. Institute of Medicine. Future Directions for the National Healthcare Quality and Disparities Reports. Available at: http://iom.edu/Reports/2010/Future-Directions-for-the-National-Healthcare-Quality-and-Disparities-Reports.aspx. Accessed November 9, 2011.

        • Ingram D.
        • Franco S.
        • National Center for Health Statistics
        NCHS urban–rural classification scheme for counties.
        Vital Health Stat. 2012; 2
      14. Secretary of US Department of Health and Human Services. 2012 annual report on the quality of care for children in Medicaid and CHIP. Available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/2012-Ann-Sec-Rept.pdf. Accessed December 19, 2012.

        • Bethell C.
        Engaging families (and ourselves) in quality improvement: an optimistic and developmental perspective.
        Acad Pediatr. 2013; 13: S9-11
      15. Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project NET, Kids Inpatient Database. Total number of discharges by age group by payer, 2009. Available at: http://hcupnet.ahrq.gov/HCUPnet.jsp%3FId%3DC91CC45A93F4F24C%26Form%3DSelCROSSTAB%26JS%3DY%26Action%3D%3E%3ENext%3E%3E%26_Oneway%3DNo. Accessed September 11, 2013.

        • Epstein A.
        • Ketcham J.
        • Rathore S.
        • Groeneveld P.
        Variations in the use of an innovative technology by payer: the case of drug-eluting stents.
        Med Care. 2012; 50: 1-9
        • Wise P.
        The anatomy of a disparity in infant mortality.
        Annu Rev Public Health. 2003; 24: 341-362
      16. National Conference of State Legislatures. Health reform. Available at: http://www.ncsl.org/documents/health/HDandACA.pdf. Accessed September 11, 2013.

      17. President’s Task Force on Environmental Health Risks and Safety Risks to Children. Coordinated federal action plan to reduce asthma disparities. Available at: http://www.epa.gov/childrenstaskforce/federal_asthma_disparities_action_plan.pdf. Accessed August 7, 2013.

      18. Health Affairs. Preventive services without cost sharing. Health Policy Brief 37. Available at: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=37. Accessed August 9, 2013.

      19. US Department of Health and Human Services. HHS releases blueprint to advance culturally and linguistically appropriate services in health and health care. Available at: http://www.hhs.gov/news/press/2013pres/04/20130424b.html. Accessed August 9, 2013.

      20. Centers for Medicare and Medicaid Services. CHIPRA quality demonstration grants summary. Available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Childrens-Health-Insurance-Program-CHIP/CHIPRA-Quality-Demonstration-Grants-Summary.html. Accessed August 7, 2013.

      21. American Academy of Pediatrics. Medicaid payment increase. Available at: http://www.aap.org/en-us/advocacy-and-policy/state-advocacy/Pages/Medicaid-Payment-Increase.aspx. Accessed August 7, 2013.

        • Clancy C.
        • Margolis P.
        • Miller M.
        Collaborative networks for both improvement and research.
        Pediatrics. 2013; 131: S210-S214
      22. US Department of Health and Human Services. HHS launches oral health initiative. Available at: http://www.hhs.gov/ash/news/20100426.html. Accessed August 9, 2009.

        • Chin M.H.
        • Alexander-Young M.
        • Burnet D.L.
        Health care quality-improvement approaches to reducing child health disparities.
        Pediatrics. 2009; 124: S224-S236
        • Van Cleave J.
        • Kuhlthau K.
        • Bloom S.
        • et al.
        Interventions to improve screening and follow-up in primary care: a systematic review of the evidence.
        Acad Pediatr. 2012; 12: 269-282
      23. Agency for Healthcare Research and Quality. AHRQ research funding priorities and special emphasis notices. Available at: http://www.ahrq.gov/funding/priorities-contacts/special-emphasis-notices/index.html. Accessed August 9, 2013.

      24. Patient Centered Outcomes Research Institute. PCORI to invest $17 million to answer long-standing questions about disparities in asthma burden and care. Available at: http://www.pcori.org/2013/funding-asthma/. Accessed August 9, 2013.

        • Polaner D.
        • Taenzer A.
        • Walker B.
        • et al.
        Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia.
        Anesth Analg. 2012; 115: 1353-1364
        • Fernald D.
        • Wearner R.
        • Dickinson W.
        The journey of primary care practices to meaningful use: a Colorado Beacon Consortium study.
        J Am Board Fam Med. 2013; 26: 603-611
        • Rothman K.
        No adjustments are needed for multiple comparisons.
        Epidemiology. 1990; 1: 43-46
      25. Agency for Healthcare Research and Quality. Data, statistics and tools: research tools and data. Available at: http://www.ahrq.gov/research/index.html. Accessed September 13, 2013.

        • Moyer V.
        • Butler M.
        Gaps in the evidence for well-child care: a challenge to our profession.
        Pediatrics. 2004; 114: 1511-1521
      26. Agency for Healthcare Research and Quality. children’s health care quality measurement and improvement activities. Available at: http://www.ahrq.gov/policymakers/chipra/index.html#Core2. Accessed September 11, 2013.