MEASURING QUALITY OF CARE FOR VULNERABLE CHILDREN

利用这个独特的机会，本研究旨在验证现有的儿童健康相关生活质量（HRQOL）工具作为弱势儿童护理质量的结果测量。作为一项正在进行的学校健康倡议的评估小组，调查人员可以获得该项目的整个范围的结构、过程和结果数据。这项名为HealthLink的倡议是全国第八大城市学区、全国人口第四大县与当地卫生保健提供者之间的一项独特的公私合作伙伴关系，旨在改变向弱势儿童提供卫生服务的方式。HealthLink的目标是“通过改善健康状况来提高圣地亚哥联合学区（SDUSD）学生的学习成绩”。HealthLink的规模（以sd美元计算的14万名学生）、范围（由150多名专业人员组成的8个工作队，代表数千人小时的工作）、学区负责人、县卫生和人类服务机构（SDHHSA）负责人以及主要社区卫生服务机构首席执行官的支持都是独一无二的。SDUSD服务的14万名学生由于其年龄、少数民族和贫困状况、有限的英语水平和医疗保险覆盖率而成为弱势群体。健康链接的主要干预措施是将每个学生与医疗之家联系起来，加强学校护士和保健提供者之间的医疗联络，解决上学的主要健康和社会障碍，并加强以学校为基础和与学校有关的保健服务。在这种变化的背景下，作为HealthLink的评估部门，研究人员将使用经过验证的儿科HRQOL测量方法PedsQLTM来评估和监测这些儿童的HRQOL。将分析PedsQLTM评分与作为HealthLink的一部分收集的结构、过程和结果数据的关系，以检验PedsQLTM评估护理质量变化和变化的能力。具体目标是：1)通过检查PedsQLTM与结构、过程和护理结果之间的关系，实地测试PedsQLTM作为护理质量的结果指标；2)将PedsQLTM翻译成阈值语言，如他加洛语和越南语（PedsQLTM已被翻译成西班牙语）。可在购买或改善保健服务时使用经过验证的儿科保健服务质量结果衡量标准，并表明社区必须采取哪些措施才能向其子女提供高质量的保健服务。

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.