Monitoring MCHB’s Monitoring MCHB’s Six Core Outcomes Six Core Outcomes for CSHCNfor CSHCN

Paul Newacheck, DrPHPaul Newacheck, DrPH

MCH Policy Research CenterMCH Policy Research Center

Attributes of the MCHB Attributes of the MCHB Monitoring ApproachMonitoring Approach

Multilevel: national and state level Multilevel: national and state level measurementmeasurement

Multiple time points to measure progress: Multiple time points to measure progress: baseline, intermediate and endpoint baseline, intermediate and endpoint measurementmeasurement

Sensitive to detecting bottlenecksSensitive to detecting bottlenecks Cost-effective to implementCost-effective to implement

Measurement ApproachMeasurement Approach

Each core outcome disaggregated into Each core outcome disaggregated into componentscomponents

For each component, criteria were established For each component, criteria were established that can be measured using the National that can be measured using the National Survey of CSHCNSurvey of CSHCN

Successful attainment of a core outcome is Successful attainment of a core outcome is based on a sample child meeting the criteria based on a sample child meeting the criteria for its componentsfor its components

Results are summed across entire sample to Results are summed across entire sample to produce national level estimates of how well produce national level estimates of how well we are doing with each core outcomewe are doing with each core outcome

Measurement ContinuedMeasurement Continued

The same approach is used to produce state The same approach is used to produce state level estimates for the core outcomeslevel estimates for the core outcomes

Basic approach is to assume 100% success Basic approach is to assume 100% success and then subtract children who do not meet and then subtract children who do not meet one or more componentsone or more components

The National Survey of CSHCN is used for 5 The National Survey of CSHCN is used for 5 of the core outcomesof the core outcomes

The National Health Interview Survey is used The National Health Interview Survey is used for the core outcome on screeningfor the core outcome on screening

Goal #1Goal #1

Families of CSHCN will partner in Families of CSHCN will partner in decision making and will be satisfied decision making and will be satisfied with the services they receivewith the services they receive

1.1. Doctors make family feel like a partner Doctors make family feel like a partner

2.2. Family is very satisfied with overall care Family is very satisfied with overall care experienceexperience

Estimated Proportion of CSHCN Meeting Goal: Estimated Proportion of CSHCN Meeting Goal: 57.5%57.5%

Goal #2Goal #2 All CSHCN will receive coordinated ongoing All CSHCN will receive coordinated ongoing

comprehensive care within a medical homecomprehensive care within a medical home1.1. Child has a usual source of care and a personal Child has a usual source of care and a personal

doctor or nursedoctor or nurse2.2. The family experiences no problems in obtaining The family experiences no problems in obtaining

referrals for specialistsreferrals for specialists3.3. Effective care coordination is available when neededEffective care coordination is available when needed Care provided is family centeredCare provided is family centered

• Spend enough time

• Sensitive to culture• Listen carefully • Provide needed info1. Make family feel like a partner

Estimated Proportion of CSHCN Meeting Goal: Estimated Proportion of CSHCN Meeting Goal: 52.6%52.6%

Goal #3Goal #3

All CSHCN will have adequate public and/or All CSHCN will have adequate public and/or private insurance to pay for the services they private insurance to pay for the services they needneed

1.1. Child has private or public health insurance at Child has private or public health insurance at the time of the surveythe time of the survey

2.2. Child had no gaps in coverage during past 12 Child had no gaps in coverage during past 12 monthsmonths

3.3. Health insurance covers services that meet the Health insurance covers services that meet the child’s needschild’s needs

Costs not covered by insurance are reasonable Costs not covered by insurance are reasonable Health insurance permits the child to see the Health insurance permits the child to see the

providers he or she needsproviders he or she needsEstimated proportion of CSHCN Meeting Goal: Estimated proportion of CSHCN Meeting Goal: 59.6%59.6%

Goal #4Goal #4

Children will be screened early and Children will be screened early and continuously for special health care needscontinuously for special health care needs1. 1. All children receive at least annual preventive All children receive at least annual preventive

medical visitsmedical visits2. All children receive at least annual 2. All children receive at least annual

preventive dental visitspreventive dental visits

Estimated Proportion of Children Meeting Goal: Estimated Proportion of Children Meeting Goal: 51.6%51.6%

Goal #5Goal #5

Community-based services for CSHCN Community-based services for CSHCN will be organized so families can use will be organized so families can use them easilythem easily

1.1. Services are usually or always organized for Services are usually or always organized for easy useeasy use

Estimated Proportion of CSHCN Meeting Goal: Estimated Proportion of CSHCN Meeting Goal: 74.3%74.3%

Goal #6Goal #6

Youth with special needs will receive Youth with special needs will receive services necessary to support the services necessary to support the transition to adulthoodtransition to adulthood

1.1. Teens receive guidance and support in Teens receive guidance and support in the transition to adult health carethe transition to adult health care

2.2. Teens receive vocational and career Teens receive vocational and career training to prepare for adult jobtraining to prepare for adult job

Estimated Proportions of Teen CSHCN Meeting Goal: Estimated Proportions of Teen CSHCN Meeting Goal: 5.8%5.8%

Summary: Where We Summary: Where We StandStand

A strong national foundation exists A strong national foundation exists for all goals except transitionfor all goals except transition

Children with more significant Children with more significant special needs are likely to do worsespecial needs are likely to do worse

Strengths of Monitoring Strengths of Monitoring ApproachApproach

Family based monitoringFamily based monitoring Nationally representative sampleNationally representative sample State level dataState level data Planned repetitionPlanned repetition

Weaknesses of Monitoring Weaknesses of Monitoring ApproachApproach

Family based monitoringFamily based monitoring Nationally representative sampleNationally representative sample State level dataState level data Planned repetitionPlanned repetition

Next StepsNext Steps

Finalize and disseminate paper Finalize and disseminate paper describing monitoring strategy and describing monitoring strategy and baseline resultsbaseline results

Begin planning process for 2005 Begin planning process for 2005 National Survey of CSHCNNational Survey of CSHCN

Develop strategy for interim Develop strategy for interim measurement of success in achieving measurement of success in achieving the core outcomesthe core outcomes