MEASURING QUALITY OF CARE FOR VULNERABLE CHILDREN

利用一个独特的机会，这项研究的目的是验证现有的儿科健康相关生活质量(HRQOL)工具作为弱势儿童护理质量的结果衡量标准。作为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全部范围的结构、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、全国人口第四多的县与当地医疗保健提供者之间独特的公私合作伙伴关系，旨在改变向弱势儿童提供医疗服务的方式。Healthlink宣称的目标是“通过改善学生的健康状况来提高圣地亚哥联合学区学生的成绩”。Healthlink的独特之处在于它的规模(南加州大学的140,000名学生)、其范围(八个由150多名专业人员组成的特别工作组，代表着数千人/小时的工作)，以及它得到的校区总监、县卫生与公众服务局(SDHHSA)局长和主要社区卫生服务提供者的首席执行官的支持。由于年龄、少数族裔和贫困状况、有限的英语水平和医疗保险覆盖率，SDUnited为14万名学生提供服务，这是一个弱势群体。HealthLink的主要干预措施是将每个学生与医疗院联系起来，加强学校护士和卫生保健提供者之间的医疗联系，解决上学的主要健康和社会障碍，以及加强以学校为基础和与学校联系的卫生服务。在这一变化的背景下，作为HealthLink的评估机构，调查人员将使用经过验证的儿科HRQOL测量工具PedsQLTM来评估和监测这些儿童的HRQOL。PedsQLTM分数将根据作为HealthLink的一部分收集的结构、过程和结果数据进行分析，以检查PedsQLTM评估护理质量变化和变化的能力。具体目标是：1)实地测试PedsQLTM作为护理质量的结果指标，检查PedsQLTM与一段时间内和跨时间护理的结构、过程和结果之间的关系；2)将PedsQLTM翻译成塔加洛语和越南语等门槛语言(PedsQLTM已被翻译成西班牙语)。儿科保健服务质量的有效结果衡量可用于购买或改善保健服务，并证明社区必须做些什么才能向其儿童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.