ISSUES IN STUDYING THE EFFECTIVENESS OF HEALTH-SERVICES FOR CHILDREN

Objectives. To discuss issues in studying the effectiveness of health services for children, suggest areas in which more research is needed, and recommend strategies for future research. Principal Findings. Iss ues that should be considered include the choice of perspective, which will help determine the interventions studied and the measures of eff ectiveness and cost-effectiveness chosen. Unique challenges in this ar ea include the fact that serious measurable morbidity is relatively un common in children, that causal relationships between services and out comes may be difficult to establish, and that standard measures of cos t-effectiveness may fail to accurately measure important benefits, suc h as reduced parental anxiety. More research is needed on high-risk an d health-promoting behaviors, on critical parent behaviors, on classif ying children by vulnerability status, on modes of delivery of prevent ive care, and on violence prevention. Recommendations. Group-randomize d designs and observational research designs that take advantage of na tural variations in practice may be increasingly useful in effectivene ss studies. Parent- and patient-reported measures of health status and quality of life should be made briefer and more practical for routine use, and better measures of cost-effectiveness are needed. Future res earch efforts can best be supported by the concerted efforts of variou s constituencies, including health plans, providers, patients, researc hers, and the government.