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## Complete Summary

#### TITLE

Effect of care provided on parental confidence: proportion of children
whose parents reported care had a positive influence on their confidence
in parenting their child and managing their responsibilities.

#### SOURCE(S)

Bethell C, Peck C, Schor E. Assessing health system provision of
well-child care: the Promoting Healthy Development Survey.
Pediatrics2001 May;107(5):1084-94.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11331691)

Child and Adolescent Health Measurement Initiative (CAHMI). The
promoting healthy development survey. Portland (OR): CAHMI - The Child
and Adolescent Health Measurement Initiative; 2001. 16 p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Patient Experience

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the proportion of children whose parents
reported a positive influence on confidence in parenting their child and
managing their responsibilities (e.g., doing things for child to help
him/her grow and learn, protecting child from injuries, addressing
special concerns, and managing parenting responsibilities).

#### RATIONALE

High quality care should empower and enhance the parent self-efficacy.

#### PRIMARY CLINICAL COMPONENT

Effect of care on parental confidence; parenting; parental
responsibilities

#### DENOMINATOR DESCRIPTION

Children age 3 months to 48 months who received a well-child visit in
the last 12 months and whose parents answered at least half of the items
in the \"Effect of Care Provided\" scale on the Promoting Healthy
Development Survey (PHDS)

#### NUMERATOR DESCRIPTION

Children whose parents responded \"I Feel a Lot More Confident\" and \"I
Feel a Little More Confident\" to all of the items in the \"Effect of
Care Provided\" scale (see the related \"Numerator
Inclusions/Exclusions\" field in the Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

-   Focus groups

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Overall poor quality for the performance measured\
Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Bethell C, Peck C, Schor E. Assessing health system provision of
well-child care: the Promoting Healthy Development Survey.
Pediatrics2001 May;107(5):1084-94.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11331691)

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Collaborative inter-organizational quality improvement\
External oversight/Medicaid\
Internal quality improvement\
National reporting\
Quality of care research

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses\
Nurses\
Physician Assistants\
Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Children age 3 months to 48 months

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Patient-centeredness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Children age 3 months to 48 months who received a well-child visit in
the last 12 months

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Children age 3 months to 48 months who received a well-child visit in
the last 12 months and whose parents answered at least half of the items
in the \"Effect of Care Provided\" scale on the Promoting Healthy
Development Survey (PHDS)

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Encounter\
Patient Characteristic

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Children whose parents responded \"I Feel a Lot More Confident\" and \"I
Feel a Little More Confident\" to all of the items in the \"Effect of
Care Provided\" scale

From the responses, a composite measure score is calculated\* in which a
higher score is associated with better quality.

\***Note**: Scoring process:

1.  Individual items are recoded so that \"I Feel a Lot More Confident\"
    and \"I Feel a Little More Confident\" responses are recoded into
    100 and \"I Do Not Feel More or Less Confident\" and \"I Feel Less
    Confident\" responses are recoded into 0.

2.  Mean calculated across all of the items.

3.  Children who have mean score = 100 are identified and recoded
    to 100. Those who have a mean score of less than a 100 are recoded
    to 0.

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Patient survey

#### LEVEL OF DETERMINATION OF QUALITY

Not Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Non-weighted Score/Composite/Scale

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Analysis by high-risk subgroup (stratification on vulnerable
populations)\
Analysis by subgroup (stratification on patient factors, geographic
factors, etc.)

#### DESCRIPTION OF ALLOWANCE FOR PATIENT FACTORS

Although no stratification is required, the Promoting Healthy
Development Survey (PHDS) includes a number of variables that allow for
stratification of the findings by possible vulnerability:

-   Child demographic characteristics (e.g., the child\'s age, race)

-   Child health and descriptive characteristics (e.g., children at high
    risk for developmental, behavioral or social delays, special health
    care needs)

-   Parent health characteristics (e.g., children whose parents are
    experiencing symptoms of depression)

#### STANDARD OF COMPARISON

External comparison at a point in time\
External comparison of time trends\
Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

**1999: Pilot Testing by Mail in Three Health Plans**

-   Psychometric analyses demonstrated that the Promoting Healthy
    Development Survey (PHDS) quality measure scales have strong
    construct validity and internal consistency (reliability). Findings
    are displayed in the article, \"Assessing Health System Provision of
    Well-child Cared: the Promoting Healthy Development Survey.\"

-   In-depth cognitive testing of the draft survey was conducted with 15
    families representing a range of socioeconomic and demographic
    groups, as well as different types of health insurance coverage, age
    of child, age and sex or parent, and number of children in family.
    Survey design and formatting was finalized with input from a group
    of experts and family representatives. Reliability assessments
    indicated the PHDS to be written at the 8th-9th grade reading level.
    Cognitive testing confirmed the readability of the PHDS for people
    across a range of educational levels.

**2000: Implementation by Mail to Medicaid Clients**

-   Psychometric analyses demonstrated that the PHDS quality measure
    scales have strong construct validity and internal consistency
    (reliability). These findings are displayed in the CAHMI Report,
    \"Summary Testing and Findings of the PHDS in Maine.\"

**2000: Implementation by Mail to Washington Medicaid Clients**

-   Psychometric analyses demonstrated that the PHDS quality measure
    scales have strong construct validity and internal consistency
    (reliability). These findings are displayed in the CAHMI Report,
    \"PHDS Results: In Washington State.\"

**2001-2003: Development and Implementation of the Provider-Level PHDS.
October 2001-March 2003**

-   Focus groups and cognitive interviews with 35 health care providers
    in Vermont and Washington and 20 parents of young children in
    Vermont to inform item-reduction, administration specifications, and
    reporting templates.

-   Psychometric analyses demonstrated that the PHDS quality measure
    scales have strong construct validity and internal consistency
    (reliability). These findings are displayed in the CAHMI reports,
    \"Overview of the Round 1 Implementation of the PHDS in Mousetrap\"
    and \"University Pediatrics: Round 2 \-- In-Office Implementation of
    the PHDS Key Findings.\"

#### EVIDENCE FOR RELIABILITY/VALIDITY TESTING

Bethell C, Peck C, Schor E. Assessing health system provision of
well-child care: the Promoting Healthy Development Survey.
Pediatrics2001 May;107(5):1084-94.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11331691)

Bethell C, Peck C. CAHMI quality measures: promoting healthy development
survey. Summary of testing and findings in Maine. Portland (OR): Child
and Adolescent Health Measurement Initiative (CAHMI); 2000 Sep. 51 p.

Bethell C, Peck C. Medicaid parents experience with the health care
system: summary of findings from a survey of parents of young children
enrolled in Medicaid in three ABCD states. New York (NY): Commonwealth
Fund; 2001.

Child and Adolescent Health Measurement Initiative (CAHMI). Child and
adolescent health measurement initiative: Washington State Healthy
options. Promoting healthy development survey (PHDS): 2000 results.
Portland (OR): Child and Adolescent Health Measurement Initiative,
Foundation for Accountability; 2000. 59 p.

Child and Adolescent Health Measurement Initiative (CAHMI). Overview of
the round 1 implementation of the PHDS in mousetrap and university
pediatrics. Portland (OR): Child and Adolescent Health Measurement
Initiative (CAHMI); 27 p.

### Identifying Information

#### ORIGINAL TITLE

Effect of care provided on parental confidence: proportion of children
whose parents reported care had a positive influence on their confidence
in parenting their child and managing their responsibilities.

#### MEASURE COLLECTION

[Promoting Healthy Development Survey
(PHDS)](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1833&doc=10338)

#### MEASURE SET NAME

[Effect of Care Provided on Parental
Confidence](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1833&doc=10379)

#### DEVELOPER

Child and Adolescent Health Measurement Initiative

#### FUNDING SOURCE(S)

The Commonwealth Fund

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Christina Bethell, PhD, MBA, MPH; Colleen Reuland, MS; Brooke Latzke, BS

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

None

#### ENDORSER

National Quality Forum

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2001 Jan

#### REVISION DATE

2006 Dec

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

Bethell C, Peck C, Schor E. Assessing health system provision of
well-child care: the Promoting Healthy Development Survey.
Pediatrics2001 May;107(5):1084-94.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11331691)

Child and Adolescent Health Measurement Initiative (CAHMI). The
promoting healthy development survey. Portland (OR): CAHMI - The Child
and Adolescent Health Measurement Initiative; 2001. 16 p.

#### MEASURE AVAILABILITY

The individual measure, \"Effect of Care Provided on Parental
Confidence: Proportion of Children whose Parents Reported Care had a
Positive Influence on their Confidence in Parenting their Child and
Managing their Responsibilities,\" is published in \"Promoting Healthy
Development Survey (mail version).\" This survey is available from the
[Child and Adolescent Health Measurement Initiative (CAHMI) Web
site](http://cahmi.org/pages/Sections.aspx?section=8).

For further information, please contact the Child and Adolescent Health
Measurement Initiative (CAHMI) at: 707 SW Gaines Street, Portland, OR
97239-3098; Phone: 503-494-1930; Fax: 503-494-2473; Web site:
[www.cahmi.org](http://www.cahmi.org/).

#### COMPANION DOCUMENTS

The following are available:

-   Child and Adolescent Health Measurement Initiative (CAHMI). The
    promoting healthy development survey: implementation guidelines.
    Portland (OR): CAHMI - The Child and Adolescent Health Measurement
    Initiative, Oregon Health & Science University; 179 p. This document
    is available in Portable Document Format (PDF) from the [Child and
    Adolescent Health Measurement Initiative (CAHMI) Web
    site](http://cahmi.org/ViewDocument.aspx?DocumentID=182).

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on November 28, 2007.
The information was verified by the measure developer on January 3,
2008.

#### COPYRIGHT STATEMENT

© CAHMI - Child and Adolescent Health Measurement Initiative

The Child and Adolescent Health Measurement Initiative (CAHMI) quality
measure tools (including sampling, administration, analysis and
reporting specifications) are available for free on the CAHMI Web site
([www.cahmi.org](http://www.cahmi.org/)) thanks to past and current
support from the Packard Foundation, Commonwealth Fund and the Robert
Wood Johnson Foundation. All CAHMI quality measures are copyrighted by
the CAHMI. Should you use any of the material from NQMC, please
reference it appropriately.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008