Children's View on Quality Should be Considered

Early in his term President Barack Obama signed into law the Children’s Health Insurance Program Reauthorization Act (CHIPRA). CHIPRA promised a “new day for children’s health care quality” and launched a new coordinated effort from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) to implement its quality provisions.

Today, AHRQ’s National Advisory Council for Healthcare Research and CMS’s Quality Subcommittee on Quality Measures for Children’s Healthcare in Medicaid and Children’s Health Insurance Programs (CHIP) are holding a two-day meeting (July 22-23) on healthcare quality and research on issues related to pediatric care. This inaugural meeting is an exciting step forward in the implementation of CHIPRA and pediatric quality measures, an issue that two INQRI grantees have researched extensively.

Nearly half of the 7.6 million children hospitalized every year in the United States are over age 6, yet no one ever systematically asks these children about their hospital experiences or the quality of care they have received. Instead they turn to their parents to answer for them.

Columbus Children’s Hospital researchers Nancy Ryan-Wenger and William Gardner say too often children are the “silent consumers of care.” Their INQRI research of hospitalized children has shown that seeking answers from parents is not an accurate measure of children’s perceptions of their care. In fact, children prioritize an entirely different set of factors when rating their hospital experience. The graph below shows that while only about 10% of parents view “check on me often” as an important factor in the care of their children, children see this as a very important measure of their care. And, the list goes on from there.

Through their research, Ryan-Wenger and Gardner are hoping to improve the reliability of tools to measure children’s health care, an effort that has great implications for changing nursing practice and improving care. Why are children’s perceptions important? Early experiences with medical care can greatly impact future decision-making about seeking care. It can even influence future career decisions in a time when bringing new nurses and doctors into the system is essential and becoming increasingly important to the success of American healthcare.

Ryan-Wenger and Gardner recommend both adding a “quality of care from the hospitalized children’s perspective” component to existing nursing sensitive indicators and working to develop and implement a standard, reliable measure of a “children’s hospital experience scale.” They provide a sample concept, reproduced below.

As AHRQ and CMS meet with stakeholder groups this week on pediatric healthcare quality measures, they must acknowledge the difference between parents’ and children’s views of care and take that into account. There are ubiquitous surveys seeking patient views on hospital care but there are no surveys that ask children to answer directly. Ryan-Wenger and Gardner say this has to change because children’s opinions matter.

For more on Ryan-Wenger and Gardner’s study, please click here.