ASSURING QUALITY OF CARE FOR CHILDREN WITH SPECIAL NEEDS IN MANAGED CARE ORGANIZATIONS - ROLES FOR PEDIATRICIANS

Increasing numbers of children with special health care needs are enro lling in managed care programs. Although managed care may improve serv ice coordination and use of primary care, it may also threaten health outcomes for these children by potentially decreasing access to the ra nge of needed services, eroding progress in developing community-based service systems, and failing to assure quality of care. To date, few frameworks have been proposed to assess quality of care for this popul ation of children in managed care organizations. In this article, we a dapt the Institute of Medicine's definition of quality and identify si x key components: content of service delivery systems, the nature of d esired health outcomes, risks associated with service delivery, constr aints of care, interpersonal dimensions, and attention to developmenta l issues. These components can be assessed at three levels: the indivi dual, the health plan, and the community. Pediatricians and other chil d health professionals have critical roles to play in assuring that po licies and practices within managed care organizations promote a high quality of care for this vulnerable population of children.