Methodologic challenges in developing and implementing measures of qualityfor child health care

Objective.-To review the major building blocks in measurement of quality fo r child health care, with recommendations for future research. Methods.-We describe a framework of building blocks for quality measurement and discuss how an investigator's choices for each component are constrain ed by the special features of child health care. Results.-Methodologic challenges for children's health care include develop mental change and dependency on others, fragmentary care and inadequate hea lth care data, unusual care settings, potential for long-term consequences, proxy reporting of outcomes and patient experience, small sample sizes, an d lack of evidence that links processes and outcomes of care and of methods for risk adjustment. We cite examples of child-specific measures of qualit y that illustrate solutions to these challenges. Conclusions.-Children are different from adults, and measures of health car e quality for children must differ from those for adults. We suggest future research on measures of quality directed toward overcoming the methodologi c problems specific to child health care.