2002
Primary Health Care Policy Fellows

Child Health Care Quality: A Need for System Change

 

Janet Farmer, PhD, ABPP
University of Missouri-Columbia
Association of Schools of Allied Health Professions

Peter Gergen, MD
Agency for Healthcare Research and Quality

John Gums, Pharm.D.
University of Florida
American College of Clinical Pharmacy
American Association of Colleges of Pharmacy

Mark Rosenberg, MD
American Academy of Pediatrics

Judy Shaw, RN, MPH
University of Vermont
Ambulatory Pediatric Association

Donna Vivio, RN, CNM, MPH, MS
American College of Nurse-Midwives

 

Child Health Care Quality: A Need for System Change

The Secretary of the Department of Health and Human Services (DHHS) can provide an additional stimulus for innovative state programs to improve the health care of children. A focus on quality preventive health care will recognize the new morbidity of health care, a shift away from the acute care that is the current basis of health care in America. Innovative state programs will build on best practices for the delivery of primary health care to children and their families in the community.

The recent Institute of Medicine report on Crossing the Quality Chasm presents a national agenda for redesigning the 21st century health care system, but it does not explicitly include children and families or issues that are unique to the healthcare of children. For example, the IOM report identifies a set of priority conditions that are mainly focused on the acute and chronic health needs of the adult population (e.g., cancer, heart disease, Alzheimer’s) and do not account for the burden of childhood illness. Ironically, the prevalence of many adult conditions could be reduced if quality preventive care were delivered to children in ways that address lifestyle behaviors that are risk factors for these conditions.

Thus far preventive health care has failed to stem the rise in prevalence of adult conditions appearing in children, such as obesity, diabetes and mental health disorders. A new approach that recognizes the value of an informed family and coordination of care within the community is an important step in preventing these problems. A system change for child health care quality is needed.

Recommendations:

  1. The DHHS should request an IOM follow up report that highlights the key areas of children's health that are not addressed in the report.
  2. To promote quality at the state level, we recommend that the DHHS charge the Governor of each state to establish an Advisory Council on Improving Children's Health that includes representatives of state agencies, health care providers, community organizations, the private sector and families. The purpose of this state Advisory Council would be to build on existing community partnerships for child health promotion in accordance with the current DHHS initiatives. The Council would help to

As an example, the state of Vermont has produced a statewide, outcome-based child health plan in collaboration with families, state agencies, private health care providers, and community organizations. This serves as an organizational tool that defines priorities for children’s health, provides infrastructure to support statewide partnerships, and aligns performance measurement with targeted outcomes.

  1. At the federal level, the DHHS should establish an interagency advisory council to provide guidance to these state councils. Unlike existing federal interagency councils, which are focused on certain populations of children, this advisory council would have broad responsibility for assuring the health of all children. Among its duties, this federal advisory council should determine incentives for states that implement these recommendations.

The benefits of these recommendations include:

Our vision is that every child should have the opportunity to be healthy and to stay healthy.

Return to the Fellows' Policy Papers