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Methodological Considerations and Comparisons With a System for Adult Women

Mark A. Schuster, MD, PhD; Steven M. Asch, MD, MPH; Elizabeth A. McGlynn, PhD; Eve A. Kerr, MD, MPH; Alison M. Hardy, MPH; Deidre S. Gifford, MD, MPH

Arch Pediatr Adolesc Med. 1997;151(11):1085-1092.

Abstract
Objectives
To describe the development of a pediatric quality of care measurement system designed to cover multiple clinical topics that could be applied to enrollees in managed care organizations and to compare the development of this system with the concurrent development of a similar system for adult women.

Design
Indicators were developed for 21 pediatric (ages 0-18 years) clinical topics and 20 adult (ages 17-50 years) women's clinical topics. Indicators were classified by the strength of evidence supporting them. A modified Delphi method was used to obtain validity and feasibility ratings from a pediatric expert panel and an adult women's expert panel. Indicators were categorized by type of care (preventive, acute, or chronic), function (screening, diagnosis, treatment, or follow up), and modality (history, physical examination, laboratory/radiology study, medication, other intervention, or other contact).

Results
Of 557 pediatric and 391 adult women's proposed indicators, 453 (81%) and 340 (87%), respectively, were retained by the 2 expert panels. A lower percentage of final pediatric indicators than adult indicators were based on randomized, controlled trials and other rigorous studies (18% vs 40%, P<.001). The expert panels were more likely to retain indicators based on rigorous studies (93% retained) than on descriptive studies and expert opinion (81% retained, P<.001). A higher percentage of pediatric indicators than women's indicators were for preventive care (30% vs 11%, P<.001) and a lower percentage were for acute care (36% vs 49%, P<.001) or chronic care (34% vs 41%, P=.06).

Conclusions
This study contributes to the field of pediatric quality of care assessment by providing many more indicators than have been available previously and by documenting the strength of evidence supporting these indicators. Formal consensus methods are essential for the development of pediatric quality measures because the evidence base for pediatric care is more limited than for adult care.

Arch Pediatr Adolesc Med. 1997;151:1085-1092

Author Affiliations
From RAND, Santa Monica, Calif (Drs Schuster, Asch, McGlynn, and Kerr and Ms Hardy); the Department of Pediatrics, University of California, Los Angeles (Dr Schuster); the West Los Angeles Veterans' Administration Hospital, University of California, Los Angeles (Dr Asch); the Department of Medicine, University of Michigan, Ann Arbor (Dr Kerr); Ann Arbor Veterans Administration Medical Center Health Services Research and Development Field Program (Dr Kerr); and the Women and Infants Hospital, Brown University School of Medicine, Providence, RI (Dr Gifford).

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