Assessing health system provision of well-child care: The Promoting Healthy Development Survey

Background. Preventive care guidelines for children include parent educatio n and counseling, developmental assessment, and screening for psychosocial and safety risks. Health care providers are in a unique position to identif y and follow up on potential problems and to influence parenting knowledge, attitudes, and behavior to ensure the healthy development of young childre n. Few quality measures are available to assess health care system performa nce in this important area. Objective. To develop a feasible, valid, and reliable methodology for evalu ating health care system performance in providing family-centered anticipat ory guidance and child and family assessment services on behalf of children from birth through 48 months old. Methods. The Promoting Healthy Development Survey (PHDS) was developed and tested with a diverse group of families in 3 managed care organizations (n = 1478). A standard mail administration protocol was used, including an inf ormed consent with a waiver of documentation, 2 mailings, a postcard remind er, and telephone reminders. The 36-item parent survey assesses whether hea lth care providers(1) talk with parents about topics recommended in Bright Futures and the American Academy of Pediatrics Guidelines for Health Superv ision,(2) provide follow-up for children who may be at risk for development al problems,(3) and address psychosocial well-being and safety within the f amily. The PHDS also assesses the degree to which parent's interactions wit h providers are family-centered, helpful, and facilitate parental confidenc e. Psychometric, bivariate, and multivariate analyses were conducted to ass ess the reliability, validity, and patterns of variation in the seven quali ty measures derived from the PHDS. Results. Psychometric analyses demonstrated that the PHDS quality measure s cales have strong construct validity (mean factor loading: 0.69) and intern al consistency (mean Cronbach's alpha: 0.80). Parents reporting positive pa renting behaviors had significantly higher scores on the anticipatory guida nce quality measure compared with parents not reporting positive behaviors. Parents who reported that their questions on specific anticipatory guidanc e topics were answered were more likely to report higher confidence in rela ted parenting activities (odds ratio [OR]: 5.9, 95% confidence interval [CI ]: 3.4-10.2; OR: 8.3, 95% CI: 5-13.8) and were less likely to report concer ns about their child's development in related areas compared with parents w ho reported they wished they had talked more with their child's doctor abou t these topics (OR: 0.46, 95% CI: 0.29-0.72; OR: 0.58, 95% CI: 0.37-0.89). The 7 PHDS quality measure scores for health plans ranged from 17 to 67 (on a 0-100 scale; where 100 is the best score possible) and varied significan tly across health plans. Performance was highest for provision of anticipat ory guidance information from health plans and lowest for family psychosoci al assessment. Scores for families with Medicaid coverage were significantl y higher on 2 of the PHDS measures and significantly lower for 3 measures c ompared with scores for families with commercial insurance. Age of child, w hether child is firstborn, parental marital status, education, income, and race were significant predictors for 1 or more of the PHDS quality measures (average R-2 = 0.05). Conclusions. The PHDS provides a comprehensive, psychometrically valid and reliable assessment of how well health plans and the health care providers working within these plans promote the healthy development of young childre n. The PHDS seems to differentiate among health care plans and among the di fferent aspects of preventive care provided within a health plan. For the p opulation studied here, there is significant room for improvement in ensuri ng families and children receive appropriate and family-centered care to pr omote the healthy development of children between 3 and 48 months old. Beca use the PHDS is conceptually based on national recommendations for child he alth supervision, improved performance on the PHDS would indicate greater a dherence to these national recommendations and progress toward the achievem ent of Healthy People 2010 goals. The generalizability of the findings pres ented in this report are being examined using data collected in 5 statewide Medicaid samples (N = 11 696) and data from the National Survey of Early C hildhood Health, which has incorporated most of the PHDS items.