RESUMO
The health development organization (HDO) is a new approach to the organization and delivery of children's health and social services. The HDO would combine the best features of vertically integrated HMOs with horizontally integrated, child-focused social services and longitudinally integrated health promotion strategies. Its mandate would be to develop the health of children in a community. The impetus for creating HDOs is a growing body of evidence in chronic disease epidemiology, developmental psychopathology, early intervention research, and life course cohort studies that point to childhood as the period of life during which adult health status is determined and the opportunities for health capital formation are highest. Thus, a new kind of health care organization or framework, like the HDO, is needed to integrate a full range of critical services for promoting children's development.
Assuntos
Desenvolvimento Infantil , Serviços de Saúde da Criança/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Criança , Necessidades e Demandas de Serviços de Saúde , Humanos , Modelos Organizacionais , Objetivos Organizacionais , Técnicas de Planejamento , Estados UnidosRESUMO
This study examines psychometric properties of the Civilian Mississippi Scale for posttraumatic stress disorder when administered in a community survey of 656 persons following the 1989 Loma Prieta earthquake. Internal consistency was lower (Cronbach's alpha = .73) than for previous analyses of civilian and combat versions of the Mississippi Scale. The analysis produced one strong factor composed of 25 items with regular wording and a second, weaker factor composed of 10 items with reversed wording. Internal consistency was higher when the 10 reversed items were removed (Cronbach's alpha = .86); the two factors were negatively correlated. Traumatic experiences and psychological distress measures explained more variance in the 25-item factor than in the 35-item scale. Further studies should focus on content analysis and performance of the reversed items.
Assuntos
Desastres , Inventário de Personalidade/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , São Francisco , Transtornos de Estresse Pós-Traumáticos/psicologiaAssuntos
Cobertura do Seguro/organização & administração , Seguro Saúde , Pessoas sem Cobertura de Seguro de Saúde , Criança , Governo , Humanos , Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Medicaid , Pessoas sem Cobertura de Seguro de Saúde/legislação & jurisprudência , Pobreza , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estados UnidosRESUMO
OBJECTIVE: To evaluate whether adjusting the Health Plan Employer Data and Information Set (HEDIS) low birth weight (LBW) measure for maternal risk factors is feasible and improves its validity as a quality indicator. DATA SOURCE: The Washington State Birth Event Record Data for calendar years 1989 and 1990, including birth certificate data matched with mothers' and infants' hospital discharge records, with 5,837 records of singlet on infants identified as LBW (< 2,500 g) and a 25 percent sample ( n = 31,570) of the normal-weight births ( = 2,500 g). STUDY DESIGN: We reviewed literature on factors associated with birth weight and identified factors for risk adjustment that are associated with LBW and th at are not modifiable by the health plan . We used vit al records Data to develop and test possible risk adjustment strategies. Finally, because feasibility is important for a HEDIS measure, we assessed health plan readiness to produce a risk-adjusted measure. PRINCIPAL FINDINGS: An LBW indicator that is adjusted for maternal risks represents health plan performance better than the unadjusted rate. In the most parsimonious risk adjustment model LBW risk was higher for mothers with a history of prior preterm birth , LBW, or fet al death . Risk was also high er for primiparas or mothers with high parity, mothers less than 19 years of age, and primiparas over age 35. In a model adding race to these obstetric factors, black, Asian/Pacific Islander, or other non-white, non-Hispanic race were also significantly associated with higher LBW risk. While adjusting for maternal risk improved the LBW measure's validity, the rate adjustment magnitude was small (0.17 percentage points) for the most plausible model. Th is may not be mean in gf ul clinically or for measuring differences in quality. The costs and data collection requirements of risk adjustment could be substantial for health plans lacking access to State birth records data. CONCLUSIONS Selection of risk adjusters for quality measures depends on judgments of their effect, legitimacy, and feasibility. A comprehensive examination of validity and feasibility is needed to understand to what extent outcome measures represent quality and how their value compares to their cost of collection .
Assuntos
Peso ao Nascer , Planos de Assistência de Saúde para Empregados/normas , Recém-Nascido de Baixo Peso , Bem-Estar Materno/classificação , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/normas , Indicadores de Qualidade em Assistência à Saúde , Risco Ajustado/estatística & dados numéricos , Adulto , Causalidade , Estudos de Viabilidade , Feminino , Hospitais/normas , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Bem-Estar Materno/etnologia , Análise Multivariada , Avaliação de Resultados em Cuidados de Saúde/métodos , Probabilidade , Fatores de Risco , Washington/epidemiologiaRESUMO
Children's enrollment in the State Child Health Insurance Program (SCHIP) is a key indicator of program impact. Past studies demonstrate that many children eligible for Medicaid or for private employer-based insurance remain uninsured, indicating that eligibility does not guarantee either enrollment or access to medical care. Important features of SCHIP evaluation include not only eligibility thresholds and enrollment volume, but also program retention, transitions in coverage, and access to medical care. Focusing on SCHIP features that affect children's participation and continuity of coverage would allow states to continually improve procedures that affect enrollment. An exploration of federal and state policy options suggests several approaches for creating evaluation strategies that can stimulate ongoing improvement.
Assuntos
Implementação de Plano de Saúde , Seguro Saúde/normas , Planos Governamentais de Saúde , Gestão da Qualidade Total , Adolescente , Criança , Serviços de Saúde da Criança , Acessibilidade aos Serviços de Saúde , Humanos , Cobertura do Seguro , Seguro Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Previdência Social/legislação & jurisprudência , Planos Governamentais de Saúde/organização & administração , Planos Governamentais de Saúde/normas , Estados UnidosRESUMO
Although immunization rates among children are rising across the country, rates in inner-city areas have remained at approximately 50%-60%, < or = 30% lower than corresponding suburban or state immunization levels. The failure to raise immunization levels in poor, underserved populations is caused in part by the lack of timely and accurate child-specific immunization information for providers and parents. Immunization registries are a new tool in health care that can be used to address these and other barriers to effective immunization delivery. Moreover, immunization registries have the potential to help health care officials track and improve delivery for a broad range of important child health services. An immunization registry is a computerized database of information on children (usually preschool-age children) in a defined population (e.g. those enrolled in a health maintenance organization or living in a specific geographic area), which is used to record and track all immunizations received by each child. The registry receives the information primarily from public and private providers that administer immunizations, as well as from parents, schools, and other agencies. A fully functioning immunization registry can be used to identify individual children in need of immunizations and to report on immunization rates by population characteristics such as child age, assigned provider, or geographic area (e.g. neighborhood, city). Today, > 250 local public health departments have immunization registries that are in various stages of planning or development. Only a small number of these registries meet the minimum functional criteria of maintaining records on 95% of all eligible 2-year-old children in the target population and providing an electronic immunization record that is accessible to providers. Nascent immunization registries represent innovative technologic solutions to the challenge of monitoring health problems and health care access on a population basis. This is a fundamental activity of public health agencies, but one that is increasingly shared by large health maintenance organizations. The study of the development of immunization registries across the United States provides an important case study for how public health agencies will use the rapidly developing health information infrastructure to perform health assessment and health assurance activities in a managed care environment.
Assuntos
Imunização/estatística & dados numéricos , Administração em Saúde Pública , Sistema de Registros , Pré-Escolar , Reforma dos Serviços de Saúde , Humanos , Lactente , Área Carente de Assistência Médica , Estados Unidos , Saúde da População UrbanaRESUMO
Congressional approval of Title XXI of the Social Security Act, which created the State Children's Health Insurance Program (CHIP), is a significant public effort to expand health insurance to children. Experience with the Medicaid program suggests that eligibility does not guarantee children's enrollment or their access to needed services. This paper develops an analytic framework and presents potential indicators to evaluate CHIP's performance and its impact on access, defined broadly to include access to health insurance and access to health services. It also presents options for moving beyond minimal monitoring to an evaluation strategy that would help to improve program outcomes. The policy considerations associated with such a strategy are also discussed.
Assuntos
Serviços de Saúde da Criança/economia , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Cobertura do Seguro/legislação & jurisprudência , Planos Governamentais de Saúde/legislação & jurisprudência , Criança , Serviços de Saúde da Criança/legislação & jurisprudência , Política de Saúde , Humanos , Cobertura do Seguro/economia , Pessoas sem Cobertura de Seguro de Saúde/legislação & jurisprudência , Avaliação de Processos e Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Previdência Social/legislação & jurisprudência , Planos Governamentais de Saúde/economia , Estados UnidosAssuntos
Desenvolvimento Infantil , Serviços de Saúde da Criança/organização & administração , Atenção à Saúde/organização & administração , Pediatria/organização & administração , Criança , Serviços de Saúde da Criança/economia , Serviços de Saúde da Criança/tendências , Atenção à Saúde/tendências , Planejamento em Saúde , Humanos , Los Angeles , Estados UnidosRESUMO
OBJECTIVE: To present a framework for measuring the quality of community systems for children, based on key attributes of systems performance for children's services. We present a research agenda for refining the model, evaluating indicators across the performance domains identified, developing normative standards for performance, and assessing the empirical basis for performance criteria. PRINCIPAL FINDINGS: Systems performance can be measured. A systems approach to evaluating community systems for children needs to incorporate the multilevel service delivery networks, programs, and systems of care for children. A model of community systems performance for children includes key dimensions of structure, financing, and accountability. Attributes within these dimensions serve as indicators that communities can use to evaluate systems quality. Performance standards can be based on the evidence from field demonstrations as well as from normative assessments. RECOMMENDATIONS: The model of community systems performance should be refined and developed using empirical findings of analyses of children's systems. A set of indicators that capture vital aspects of performance and that are relevant, scientifically valid, and feasible should be developed and tested in field studies. Once indicators are evaluated for use in performance monitoring, communities will be able to implement performance monitoring.
Assuntos
Serviços de Saúde da Criança/normas , Planejamento em Saúde Comunitária/organização & administração , Pesquisa sobre Serviços de Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde , Garantia da Qualidade dos Cuidados de Saúde , Criança , Serviços de Saúde da Criança/organização & administração , Humanos , Modelos Teóricos , Guias de Prática Clínica como Assunto , Indicadores de Qualidade em Assistência à Saúde , Análise de Sistemas , Estados UnidosRESUMO
Public health and medical care interventions have produced dramatic changes in the health of children in the United States. Emerging new morbidities such as behavioral and learning disorders, and child abuse and neglect, highlight the lack of an integrated system of health. Children's developmental vulnerability, dependency, and unique morbidities have been underemphasized in the organization and delivery of health care. The Andersen and Aday model of health care utilization is used to describe financial and nonfinancial barriers to care for children that include family characteristics and organizational characteristics of the health system. Case studies of immunization delivery, children with chronic illness, and mobile populations of children reveal the mismatch between the health care system and children's basic health needs. Integrated service models for high-risk populations of children represent an essential mechanism for coordinating the delivery of medical, developmental, educational, and social services needed by children and families. Universal, coordinated public health and medical services of adequate scope and quality should be assured for children through market and health system reform.
Assuntos
Serviços de Saúde da Criança/organização & administração , Acessibilidade aos Serviços de Saúde , Adolescente , Criança , Pré-Escolar , Continuidade da Assistência ao Paciente , Demografia , Reforma dos Serviços de Saúde/normas , Humanos , Lactente , Recém-Nascido , Modelos Organizacionais , Estados UnidosRESUMO
The question of identifying and treating childhood illness confronts all new parents. Misconceptions often lead parents to manage illnesses in their young children inappropriately through overly aggressive treatment or insufficient attention. This responsibility is especially challenging for low-income new parents who lack the literacy levels needed to understand and use much of the existing health education literature and who are without access to health facilities and providers. In response to a perceived need for health information directed at low-income, low-literacy parents, students from the University of California at Los Angeles School of Public Health created an easy-to-use reference booklet called "A Parent's Guide: When Your Child Is Sick." The booklet's aim is to assist parents in treating common childhood illness and identifying more serious diseases requiring medical attention. A comprehensive and manageable amount of information is provided in the booklet. Behaviors and issues covered include (a) recognition of symptoms, (b) actions that could be taken in the home, (c) medicines that could be administered, and (d) recommendations on how persistent problems might be handled.