MEASURING QUALITY OF CARE FOR VULNERABLE CHILDREN

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Taking advantage of a singular opportunity, this research aims to validate an existing pediatric health-related quality of life (HRQOL) instrument as an outcome measure of quality of care for vulnerable children. As the evaluation team for an ongoing school health initiative, the investigators have access to structure, process, and outcomes data for the full scope of this project. This initiative, HealthLink, is a unique public/private partnership between the 8th largest urban school district in the nation, the 4th most populated county in the nation, and local health care providers to change the way health services are delivered to vulnerable children. HealthLink's stated goal is to "improve the student achievement of San Diego Unified School District (SDUSD) students by improving their health status." HealthLink is unique in its size (140,000 students in SDUSD), in its scope (eight task forces comprised of over 150 professionals, representing thousands of person-hours of work), and in the support it enjoys from the Superintendent of the school district, the head of the County's Health and Human Services Agency (SDHHSA), and from the CEO's of the major community health providers. The 140,000 students served by SDUSD represent a vulnerable population by virtue of their age, minority and poverty status, limited English proficiency, and rate of health insurance coverage. The main HealthLink interventions are to link every student with a medical home, enhance medical liaison between school nurses and health care providers, address the major health and social barriers to attendance, and enhance school-based and school-linked health services. In the context of this change, and as HealthLink's evaluative arm, the investigators will assess and monitor the HRQOL of these children using a validated pediatric HRQOL measure, the PedsQLTM. PedsQLTM scores will be analyzed in relation to structure, process, and outcomes data collected as part of HealthLink, in order to examine the ability of the PedsQLTM to assess variation in, and changes to, quality of care. Specific aims are: 1) to field test the PedsQLTM as an outcome indicator of quality of care by examining the relationship between the PedsQLTM and structures, processes, and outcomes of care within and across time and 2) to translate the PedsQLTM to threshold languages such as Tagalog and Vietnamese (the PedsQLTM has been translated to Spanish). A validated outcome measure of quality of pediatric health services can be used in the purchase or improvement of health care services and to demonstrate what communities must do in order to provide high-quality health care to their children.