Child and Adolescent Health Measurement Initiative Measuring and reporting on the presence of a medi

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Child and Adolescent Health Measurement
InitiativeMeasuring and reporting on the
presence of a medical home for all children and
CSHCN A project sponsored by the Maternal and
Child Health Bureau October 2001-October 2002
Christina Bethell, PhDDecember 2001
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Project Goal

• To develop, test, and gain consensus on a uniform
  strategy for measuring the presence of a Medical
  Home at both state and federal levels for all
  children and CSHCN.

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Process

• Conceptual framework and criteria for measurement
• Working definition
• Identify and compare options for operationalizing
  definition
• Engage advisors and stakeholders
• Disseminate findings and recommendations for
  measurement and reporting

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Conceptual framework

• Factors shaping the development of measures of
  medical home
• Purpose
• Definition
• Unit of Analysis
• Data Availability and Capacity
• Target Population

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Criteria for Measurement

• Relevance
• to families
• to policymakers
• to providers
• Feasibility
• data availability
• cost and burden
• capacity for standardization
• Scientific Soundness
• empirical evidence for definition
• reliable and valid data
• valid and accurate scoring method

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Issues in Operationalizing Working Definition

• balancing comprehensiveness with parsimony
• selecting among highly correlated concepts
• breadth vs. depth within and across definitional
  components
• relative importance of definitional components to
  child health
• anchoring experience of care to provider/usual
  source
• gaps in available data
• relevance of specific concepts to all children
• potential for valid self report

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Data for Operationalizing Working Definition

• Existing data
• National Survey on CSHCN (SLAITS)
• CAHPS 2.0H (with and without the Children with
  Chronic Conditions Module)
• MEPS
• Through the upcoming National Survey on
  Childrens Health

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Alternatives for Operationalizing Working
Definition

• specific content included for all children and
  age groups
• value assigned to responses to survey items (e.g.
  small problem getting referrals
• relative weighting of content within and across
  and definitional components
• threshold scores/responses required to count as
  having a medical home
• anchoring responses to experience of care
• creating component scores/results as well as
  overall score/results
• creating individual level as well as aggregate
  scores/results

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An Illustration Options for scoring CAHPS 2.0H
Data

• OPTION A Proportion of children with a mean
  score of 75 points across all items/definitional
  domains
• Non-CSHCN 72
• CSHCN 62
• OPTION B Proportion with mean score 75 points
  AND a personal doctor/nurse
• Non-CSHCN 61
• CSHCN 55
• OPTION C Proportion with a socre of 75 points
  on each item/definitional domain
• Non-CSHCN 53
• CSHCN 43
• OPTION D Proportion with a socre of 75 points
  on each item/definitional domain AND a personal
  doctor/nurse
• Non-CSHCN 45
• CSHCN 38

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An Illustration Options for scoring CAHPS 2.0H
Data

• OPTION CSHCN Non-CSHCN
• A 75 Mean 62 72
• B 75 Mean/DR 55 61
• C 75 Each Item 43 53
• D 75 Each/DR 38 45

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Advisor and Stakeholder Input and Review

• National advisory group meeting (Dec. 01)
• Ongoing advisory group calls/online meetings
• Stakeholder input solicited (March, 02)
• Consumer focus groups (April, 02)
• Advisor/Stakeholder Meeting (May/June, 02)

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Disseminate findings and recommendations

• MCHB/Title V programs
• National Center for Health Statistics
• NCQA/HEDIS
• CAHPS/AHRQ
• MEPS
• States/Medicaid and SCHIP Programs
• Provider QI efforts/NICHQ
• Peer review literature

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For more information

• Childs_at_facct.org
• www.facct.org/cahmi.html