DEVELOPMENT OF A QUALITY OF CARE MEASUREMENT SYSTEM FOR CHILDREN AND ADOLESCENTS - METHODOLOGICAL CONSIDERATIONS AND COMPARISONS WITH A SYSTEM FOR ADULT WOMEN

Objectives: To describe the development of a pediatric quality of care measurement system designed to cover multiple clinical topics that co uld be applied to enrollees in managed care organizations and to compa re 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 17-5 0 years) women's clinical topics. Indicators were classified by the st rength of evidence supporting them. A modified Delphi method was used to obtain validity and feasibility ratings from a pediatric expert pan el and an adult women's expert panel. Indicators were categorized by t ype of care (preventive, acute, or chronic), function (screening, diag nosis, treatment, or follow up), and modality (history, physical exami nation, laboratory/radiology study, medication, other intervention, or other contact). Results: Of 557 pediatric and 391 adult women's propo sed indicators, 453 (81%) and 340 (87%), respectively, were retained b y the 2 expert panels. A lower percentage of final pediatric indicator s than adult indicators were based on randomized, controlled trials an d other rigorous studies (18% vs 40%, P<.001). The expert panels were more likely to retain indicators based on rigorous studies (93% retain ed) than on descriptive studies and expert opinion (81% retained, P<.0 01). A higher percentage of pediatric indicators than women's indicato rs were for preventive care (30% vs 11%, P<.001) and a lower percentag e 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 pediatri c quality of care assessment by providing many more indicators than ha ve been available previously and by documenting the strength of eviden ce supporting these indicators. Formal consensus methods are essential for the development of pediatric quality measures because the evidenc e base for pediatric care is more limited than for adult care.