Assuring quality of care for children with special needs in managed care organizations: roles for pediatricians.

Increasing numbers of children with special health care needs are enrolling in managed care programs. Although managed care may improve service coordination and use of primary care, it may also threaten health outcomes for these children by potentially decreasing access to the range of needed services, eroding progress in developing community-based service systems, and failing to assure quality of care. To date, few frameworks have been proposed to assess quality of care for this population of children in managed care organizations. In this article, we adapt the Institute of Medicine's definition of quality and identify six key components: content of service delivery systems, the nature of desired health outcomes, risks associated with service delivery, constraints of care, interpersonal dimensions, and attention to developmental issues. These components can be assessed at three levels: the individual, the health plan, and the community. Pediatricians and other child health professionals have critical roles to play in assuring that policies and practices within managed care organizations promote a high quality of care for this vulnerable population of children.

Quality management in public and community health: examples from women's health.

Quality assessment and improvement activities are as relevant to the public health sector and community-based health care organizations as they are to the rest of the health care industry. This article provides a framework for the types of quality assessment and improvement approaches available to public health and community-based health care organizations and provides two examples drawn from the field of women's health. The first focuses on a population-based assessment of the performance of the health care system using indicators for the nation as a whole and for the states specifically in a women's health report card. The second focuses on measuring quality of care provided to clients of one type of safety-net organization, Title X family planning clinics. Either type of approach can serve as the basis for developing strategies for improving the performance of health care organizations.

MCH functions framework: a guide to the role of government in maternal and child health in the 21st century.

OBJECTIVES: At the close of the 20th century, the government's role in maternal and child health is in a state of transition. What is needed is a framework defining roles and responsibilities and guidance on how to operationalize these functions. This article presents the Maternal and Child Health (MCH) Functions Framework and discusses its value as an advocacy, planning, evaluation, and educational tool. METHODS: The Johns Hopkins Child and Adolescent Health Policy Center developed the Framework in collaboration with leading public health organizations. The process entailed formulating a conceptual approach and facilitating consensus among the relevant organizations. RESULTS: The Framework consists of three main components: (a) a list of ten essential public health services to promote maternal and child health, (b) an outline detailing program functions specific to MCH that apply to all levels of government and to all MCH populations, and (c) selected examples of local, state, and federal activities for implementing MCH program functions. CONCLUSIONS: The MCH Functions Framework can be used in advocacy, policy development, program planning, organizational assessment, education, and training. To date, it has been used by several state and local MCH agencies and in MCH education and training programs.