TABLE 5-2An Integrated Service System Performance Approach (Population-Level Developmental Assessment Examplea)

Performance AttributesConstructMeasurement StrategiesExample Measures
EffectivenessCare/service intervention or action achieves desired results at individual, family, and community levelsProviders are using appropriate screening/ surveillance measures to detect problemsRates of children receiving indicated assessments with appropriate instruments
EfficiencyAchieving desired results with most cost-effective use of resourcesEstimating costs of interventionsAverage expenditure per child identified
AvailabilityAbility of clients/patients to obtain care/service at the right place and right time, based on needs and is equitableParents report services are available and they can have problem assessedRates of children actually reaching indicated services
AppropriatenessCare/service provided is relevant to client/patient needs and based on established standardsRates of services based on American Academy of Pediatrics guidelinesProportion of children appropriately identified
CapabilitySelf-assessment of skill to conduct appropriate risk assessment
  1. Routine periodic survey of provider about knowledge, skill, and tracking needs
  2. Community health service—asset mapping of developmental services in community
  1. Self-assessment of skill to conduct appropriate risk assessment
  2. Adequate referral services
SafetyPotential risks of an intervention or the environment are avoided or minimizedMonitoring of avoidance of unsafe or unwarranted interventionsRates of initiation of inappropriate modes of therapy
ContinuityAbility to provide uninterrupted care/service across programs, practitioners, organizations, and levels of care/service over timeSame provider/practice conducting assessmentRates of children with regular person conducting assessment
AcceptabilityCare/service provided meets expectations of client, community, providers, and paying organizationsAssess parent satisfaction with assessment and its resultsSatisfaction with care by ethnicity, income, and practice type
CoordinationDifferent aspects of care are connected seamlesslySpectrum of care provided without conflict in advice and/or managementRates of conflicting advice or incompatible management strategies (e.g., drug incompatibilities)
EquityAbsence of systematic differences across population subgroupsPopulation-based monitoring of all aspects of health system performanceNo differences in access to or receipt of individual services

At national level, if we want to measure how care of children can impact development.

From: 5, Measuring Influences on Children’s Health

Cover of Children’s Health, The Nation’s Wealth
Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health.
National Research Council (US); Institute of Medicine (US).
Washington (DC): National Academies Press (US); 2004.
Copyright © 2004, National Academy of Sciences.

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