Does not apply to this measure

This measure is used to assess the proportion of children whose parents reported care received was helpful or very helpful in specific areas of parenting such as understanding child's behavior, protecting child from injuries, and helping the parent learn to meet their own needs. The parent is questioned as to whether the care provided was helpful, very helpful, somewhat helpful, not helpful, or item was not discussed.

Significant opportunities for improvement exist in ensuring that young children and families receive recommended preventive and developmental health care services. A growing body of literature supports the delivery of parental anticipatory guidance, assessment follow-up on the development of children, and assessment of the psychosocial well-being of families.

Few standardized quality measures are available that provide specific information about preventive health care for young children, especially on aspects of care for which parents and families are a reliable source of information about the quality of their child's health care. A majority of the measures currently used provide information about whether children come in for well-child visits (access to care measures) or are based on medical chart reviews which are not accurate for the specific level of information obtained in the Promoting Healthy Development Survey (PHDS).

Helpfulness of care; preventive and developmental health care

Children age 3 months to 48 months who received a well-child visit in the last 12 months, whose parent received the aspect of care*, and whose parent answered at least half of the items in the "Helpfulness of Care Provided" scale on the Promoting Healthy Development Survey (PHDS)

*See the "Description" field.

Children whose parents responded "Very Helpful" and "Helpful" to all of the items in the "Helpfulness of Care Provided" scale (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence
• Focus groups
• One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Overall poor quality for the performance measured
Use of this measure to improve performance

Current routine use

Collaborative inter-organizational quality improvement
External oversight/Medicaid
Internal quality improvement
National reporting
Quality of care research

Ambulatory Care

Advanced Practice Nurses
Nurses
Physician Assistants
Physicians

Individual Clinicians

Children age 3 months to 48 months

Either male or female

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Staying Healthy

Patient-centeredness

Users of care only

Children age 3 months to 48 months who received a well-child visit in the last 12 months, whose parents received the aspect of care*

*See the "Description" field.

Patients associated with provider

Inclusions
Children age 3 months to 48 months who received a well-child visit in the last 12 months, whose parent received the aspect of care*, and whose parent answered at least half of the items in the "Helpfulness of Care Provided" scale on the Promoting Healthy Development Survey (PHDS)

*See the "Description" field.

Exclusions
Unspecified

All cases in the denominator are equally eligible to appear in the numerator

Encounter
Patient Characteristic

Time window precedes index event

Inclusions
Children whose parents responded "Very Helpful" and "Helpful" to all of the items in the "Helpfulness of Care Provided" scale

From the responses, a composite measure score is calculated* in which a higher score is associated with better quality.

*Note: Scoring process:

1. Individual items are recoded so that "Very Helpful" and "Helpful" responses are recoded into 100, "Somewhat Helpful" and "Not Helpful" responses are recoded into 0, and "Did Not Discuss" responses are recoded into missing.
2. Mean calculated.
3. Children whose mean = 100 are recoded to 100 and children whose mean score is less than 100 are recoded to 0.

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Encounter or point in time

Patient survey

Not Individual Case

Unspecified

Non-weighted Score/Composite/Scale

Better quality is associated with a higher score

Analysis by high-risk subgroup (stratification on vulnerable populations)
Analysis by subgroup (stratification on patient factors, geographic factors, etc.)

Although no stratification is required, the Promoting Healthy Development Survey (PHDS) includes a number of variables that allow for stratification of the findings by possible vulnerability:

• Child demographic characteristics (e.g., the child's age, race)
• Child health and descriptive characteristics (e.g., children at high risk for developmental, behavioral or social delays, special health care needs)
• Parent health characteristics (e.g., children whose parents are experiencing symptoms of depression)

External comparison at a point in time
External comparison of time trends
Internal time comparison

1999: Pilot Testing by Mail in Three Health Plans

• Psychometric analyses demonstrated that the Promoting Healthy Development Survey (PHDS) quality measure scales have strong construct validity and internal consistency (reliability). Findings are displayed in the article, "Assessing Health System Provision of Well-child Cared: the Promoting Healthy Development Survey."
• In-depth cognitive testing of the draft survey was conducted with 15 families representing a range of socioeconomic and demographic groups, as well as different types of health insurance coverage, age of child, age and sex or parent, and number of children in family. Survey design and formatting was finalized with input from a group of experts and family representatives. Reliability assessments indicated the PHDS to be written at the 8th-9th grade reading level. Cognitive testing confirmed the readability of the PHDS for people across a range of educational levels.

2000: Implementation by Mail to Medicaid Clients

• Psychometric analyses demonstrated that the PHDS quality measure scales have strong construct validity and internal consistency (reliability). These findings are displayed in the CAHMI Report, "Summary Testing and Findings of the PHDS in Maine."

2000: Implementation by Mail to Washington Medicaid Clients

• Psychometric analyses demonstrated that the PHDS quality measure scales have strong construct validity and internal consistency (reliability). These findings are displayed in the CAHMI Report, "PHDS Results: In Washington State."

2000-2001: Implementation by Telephone Three-State Medicaid Clients

• Cognitive interviews were conducted with 20 parents of children 3 to 48 months old who were enrolled in Medicaid. Five of these interviews were conducted in-person; the remaining 15 were conducted over the telephone in order to assess the response burden and cognitive ease of the PHDS when using a telephone administration. Using behavior coding methods, for each item in the PHDS, instances where the respondent required clarification or did not appropriately answer an item were noted. Also, items where the interviewer had difficulty asking the question without edits to the wording were noted. Survey modifications were made based on findings in order to improve the reliability, validity and cognitive ease of the PHDS items.
• The PHDS was administered by telephone to parents in 3 state Medicaid programs.
• Psychometric analyses demonstrated that the PHDS quality measure scales have strong construct validity and internal consistency (reliability). These findings are displayed in the report, "Partnering with Parents to Promote the Healthy Development of Young Children Enrolled in Medicaid."

2000: A Majority of the PHDS Included in the National Survey of Early Childhood Health (NSECH)

• Psychometric analyses demonstrated that the PHDS quality measure scales have strong construct validity and internal consistency (reliability). These findings are displayed in the article, "Measuring the quality of preventive and developmental services for young children: National estimates and patterns of clinicians' performance."

2001-2003: Development and Implementation of the Provider-Level PHDS. October 2001-March 2003

• Focus groups and cognitive interviews with 35 health care providers in Vermont and Washington and 20 parents of young children in Vermont to inform item-reduction, administration specifications, and reporting templates.
• Psychometric analyses demonstrated that the PHDS quality measure scales have strong construct validity and internal consistency (reliability). These findings are displayed in the CAHMI reports, "Overview of the Round 1 Implementation of the PHDS in Mousetrap" and "University Pediatrics: Round 2 -- In-Office Implementation of the PHDS Key Findings."

2002-2004: Implementation by Telephone in Four Medicaid Agencies

• Psychometric analyses demonstrated that the PHDS quality measure scales have strong construct validity and internal consistency (reliability). These findings are displayed in the CAHMI report, "Hearing the Voices of Parents: Results from a Survey Assessing the Quality of Preventive and Developmental Services for Young Children Enrolled in Medicaid in Four States."

December 2003 - March 2004 Implementation of the PHDS in Kaiser Permanente, System, Office and Provider-Level Analysis Conducted

• Psychometric analyses demonstrated that the PHDS quality measure scales have strong construct validity and internal consistency (reliability). These findings are displayed in the draft publication, "What drives the quality of preventive and development services provided to young children? Findings from a multi-level, provider and patient-centered method to assess quality."

Helpfulness of care provided: proportion of children whose parents reported care provided was helpful or very helpful on core aspects of preventive and developmental health care.

Child and Adolescent Health Measurement Initiative

The Commonwealth Fund

Christina Bethell, PhD, MBA, MPH; Colleen Reuland, MS; Brooke Latzke, BS

None

National Quality Forum

Measure was not adapted from another source.

2001 Jan

2006 Dec

This is the current release of the measure.

This NQMC summary was completed by ECRI Institute on November 28, 2007. The information was verified by the measure developer on January 3, 2008.