Papers by Colleen Reuland
Maternal and Child Health Journal, Aug 24, 2023
Background: The 1997 legislation authorizing the United States Child Health Insurance Program spa... more Background: The 1997 legislation authorizing the United States Child Health Insurance Program sparked progress to measure and publicly report on children's healthcare services quality and system performance. To meet the moment, the national Child and Adolescent Health Measurement Initiative (CAHMI) public-private collaboration was launched to put families at the center of defining, measuring and using healthcare performance information to drive improved services quality and outcomes. Methods: Since 1996 the CAHMI followed an intentional path of collaborative action to (1) articulate shared goals for child health and advance a comprehensive, life-course and outcomes-based healthcare performance measurement and reporting framework; (2) collaborate with families, providers, payers and government agencies to specify, validate and support national, state and local use of dozens of framework aligned measures; (3) create novel public-facing digital data query, collection and reporting tools that liberate data findings for use by families, providers, advocates, policymakers, the media and researchers (Data Resource Center, Well Visit Planner); and (4) generate field building research and systems change agendas and frameworks (Prioritizing Possibilities, Engagement In Action) to catalyze prevention, flourishing and healing centered, trauma-informed, whole child and family engaged approaches, integrated systems and supportive financing and policies. Conclusions: Lessons call for a restored, sustainable family and community engaged measurement infrastructure, public activation campaigns, and undeterred federal, state and systems leadership that implement policies to incentivize, resource, measure and remove barriers to integrated systems of care that scale family engagement to equitably promote whole child, youth and family well-being. Population health requires effective family engagement. Significance Steady progress in maternal and child health policy has led to shifts that increasingly prioritize the engagement of families to shape services and integrate systems of care that equitably promote the early and lifelong health of children. The scope and scale of this progress was shaped, accelerated, and amplified by the quarter century of work of the Child and Adolescent Health Measurement Initiative (CAHMI). Understanding CAHMI's contributions highlights the fundamental role of measurement based on the voices of families to drive continued systems changes that achieve critically needed improvements required to improve the well-being of all children, youth and families. Keywords Child and adolescent health measurement initiative (CAHMI) • Family voices and family engagement • Child health care quality and systems performance measurement • Whole child and family well-being and flourishing • Children's healthcare system transformation
Pediatrics, 2004
Objective. To generate a national picture of performance in the area of preventive and developmen... more Objective. To generate a national picture of performance in the area of preventive and developmental services for children aged 4 to 35 months using 4 composite quality measures in the areas of 1) anticipatory guidance and parental education, 2) screening for family psychosocial risks, 3) screening for smoking and drug and alcohol use in the home, and 4) provision of family-centered care. Methods. Data from the National Survey on Early Childhood Health (N = 2068) were used to calculate the 4 composite performance measures, which, taken together, represent 23 topics included in the American Academy of Pediatrics health supervision guidelines. The reliability and degree of redundancy within and across these 4 measures were evaluated. Four methods for scoring these measures were used. Quality scores for subgroups of children were calculated, and logistic regression analysis was performed to examine the association of demographic, health, and health system variables with receiving recom...
ABSTRACT Background: A pre-visit, online tool can educate parents prior to a visit, elicit priori... more ABSTRACT Background: A pre-visit, online tool can educate parents prior to a visit, elicit priorities for care and enable linkage of parent reported information in the EMR for use before a well child visit. Objective: To design and assess the acceptability and feasibility of an online, parent-completed tool, inserted into the EMR, to promote adherence to Bright Futures (BF) recommendations and customizes care to meet patient/family needs. Methods: A pre-visit tool (PlanYourChild'sWellVisit tool-PCW) was developed reflecting BF recommendations for well-child care. The tool focuses on child/family health screening, identifying parent's anticipatory guidance priorities, parental education and provision of a "Visit Guide" for use during visits. Results are automatically inserted into the provider's EMR forms and used to customize the visit. Results derive from a 12 pediatrician private practice and represent 2,076 PCW completions by parents. Baseline and follow-up well child care quality, experience surveys and focus groups were conducted. Results: 43.2% of parents invited completed PCW. Median completion time was 9 minutes; 91.2% indicated comfort with length. Results were reliably transferred into EMR. Nearly 90% of parents picked priority topics to discuss. 57.7% had concerns about their child's development or behavior to discuss. Over 90% of parents reported they would recommend the PCW to other parents. 85.2% reported PCW helped prioritize topics to discuss, especially regarding their child's development. Access to online educational materials embedded in the tool was reported useful by 83.2% of parents. Each participating pediatrician reported an intention to continue use of PCW and that it improved ability to provide recommended well-child care. Providers also noted positive impact on quality of care for children whose parents did not complete the online, pre-visit tool due to the improvements made in EMR forms. Conclusions: Pre-visit patient engagement tools are feasible, effective in improving the experience of well child care visits.
Pediatrics, 2001
Background.Preventive care guidelines for children include parent education and counseling, devel... more Background.Preventive care guidelines for children include parent education and counseling, developmental assessment, and screening for psychosocial and safety risks. Health care providers are in a unique position to identify and follow up on potential problems and to influence parenting knowledge, attitudes, and behavior to ensure the healthy development of young children. Few quality measures are available to assess health care system performance in this important area.Objective.To develop a feasible, valid, and reliable methodology for evaluating health care system performance in providing family-centered anticipatory guidance and child and family assessment services on behalf of children from birth through 48 months old.Methods.The Promoting Healthy Development Survey (PHDS) was developed and tested with a diverse group of families in 3 managed care organizations (n = 1478). A standard mail administration protocol was used, including an informed consent with a waiver of document...
Medical Care, 2001
Adolescents often do not receive recommended preventive counseling and screening services. Few me... more Adolescents often do not receive recommended preventive counseling and screening services. Few measures are available to assess health care system performance in this area. Develop a reliable, valid, and feasible method for measuring adherence to consensus guidelines for adolescent preventive counseling and screening services. The 45-item Young Adult Health Care Survey (YAHCS) was tested with a diverse group of commercially and publicly insured adolescents enrolled in managed care organizations (n = 4,060). Psychometric, bivariate, and multivariate analyses were conducted to assess the reliability, validity, and patterns of variation in the preventive care measurement scales derived from the YAHCS. YAHCS measurement scales demonstrated strong construct validity (mean factor loading = 0.64) and reliability (mean Cronbach's alpha = 0.77). Average preventive counseling and screening scores ranged from 18.2% for discussing risky behavior topics to 50.4% for discussing diet, weight, and exercise topics. Adolescent demographic, health care use, and payer factors explained a small amount of variation across adolescent scores on YACHS scales (mean R2 = 0.086). Females and older teens were more likely to report private time with providers and counseling and screening on topics related to sex. Overall, the odds of receiving preventive counseling and screening for adolescents who reported having private time with providers, engaging in risky behaviors, or both were higher than for adolescents who did not meet privately or report risky behaviors (private visit OR, 3.60; 95% CI, 2.91-4.47; risky behaviors OR, 2.02; 95% CI, 1.62-2.52). The YAHCS provides a feasible, reliable, and valid method for assessing adherence to adolescent preventive services guidelines. It differentiates among varied aspects of preventive care provided to adolescents and is promising as a potential measure of health plan and provider quality. Improved performance on the YAHCS would indicate progress toward the achievement of Healthy People 2010 goals.
Pediatrics, 2004
Objective. To determine the proportion of children aged 10 to 35 months who were reported ever to... more Objective. To determine the proportion of children aged 10 to 35 months who were reported ever to have received a developmental assessment (DA) and to examine characteristics of the child, family, and health care setting associated with the receipt of a DA.Methods. The National Survey of Early Childhood Health, conducted in 2000, is a survey of 2068 parents of children 4 to 35 months of age. Children were classified as having received a DA in response to 2 questions: whether the child’s pediatric provider ever told parents that he or she was doing a “developmental assessment” and/or parents recalled explicit components of a DA, such as stacking blocks or throwing a ball. Parent-reported receipt of a DA was assessed in relationship to child and family, health care access, other measures of health care content and process, and measures of quality and satisfaction.Results. Approximately 57% of children 10 to 35 months of age ever received a DA. Forty-two percent of parents recalled eve...
New York …, 2002
Page 1. PARTNERING WITH PARENTS TO PROMOTE THE HEALTHY DEVELOPMENT OF YOUNG CHILDREN ENROLLED IN ... more Page 1. PARTNERING WITH PARENTS TO PROMOTE THE HEALTHY DEVELOPMENT OF YOUNG CHILDREN ENROLLED IN MEDICAID RESULTS FROM A SURVEY ASSESSING THE QUALITY OF PREVENTIVE AND DEVELOPMENTAL ...
Supplemental material, Supplemental_Figure for Improving autism and developmental screening and r... more Supplemental material, Supplemental_Figure for Improving autism and developmental screening and referral in US primary care practices serving Latinos by Katharine E Zuckerman, Alison E Chavez, Laura Wilson, Katie Unger, Colleen Reuland, Katrina Ramsey, Margaret King, Julie Scholz and Eric Fombonne in Autism
Autism, 2020
Improving autism spectrum disorder screening and referral in primary care may reduce autism spect... more Improving autism spectrum disorder screening and referral in primary care may reduce autism spectrum disorder disparities for Latino children. The REAL-START intervention aimed to increase primary care provider adherence to autism spectrum disorder and developmental screening guidelines, and to increase Early Intervention referral for children at developmental risk in primary care clinics serving Latinos. This quasi-experimental study enrolled six Oregon primary care clinics. Clinic staff attended one initial and three follow-up trainings. Trainings addressed screening, billing, referral, and follow-up issues specific to Latinos. Clinic leaders met with a quality improvement facilitator to review performance. Medical record review measured screening and referral at 18- and 24-month well-child visits at baseline and 3, 6, 9, and 12 months. State Early Intervention database queries assessed Early Intervention eligibility. Overall, 2224 well-child visits were assessed (39% Latino). Cli...
JAMA Pediatrics, 2018
IMPORTANCE Since 2001, the American Academy of Pediatrics has recommended universal developmental... more IMPORTANCE Since 2001, the American Academy of Pediatrics has recommended universal developmental screening and surveillance to promote early diagnosis and intervention and to improve the outcomes of children with developmental delays and disabilities. OBJECTIVE To examine the current prevalence and variation of developmental screening and surveillance of children by various sociodemographic, enabling, and health characteristics. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis of the Health Resources and Services Administration's 2016 National Survey of Children's Health-a nationally representative survey of US children completed between June 2016 and February 2017-examined 5668 randomly selected children 9 through 35 months of age whose parent or caregiver responded to the address-based survey by mail or via a website. All analyses were weighted to account for the probability of selection and nonresponse and to reflect population counts of all noninstitutionalized US children residing in housing units. MAIN OUTCOMES AND MEASURES Developmental screening was measured through a validated set of 3 items indicating receipt in the past year of parent-completed screening from a health care professional with age-appropriate content regarding language development and social behavior. Surveillance was determined by an item capturing verbal elicitation of developmental concerns by a health care professional. RESULTS Of the estimated 9.0 million children aged 9 through 35 months, an estimated 30.4% (95% CI, 28.0%-33.0%) were reported by their parent or guardian to have received a parent-completed developmental screening and 37.1% (95% CI, 34.4%-39.8%) were reported to have received developmental surveillance from a health care professional in the past year. Characteristics associated with screening and/or surveillance that remained significant after adjustment included primary household language, family structure, household education, income, medical home, past-year preventive visit, child health status, and special health care needs. Having health care that meets medical home criteria was significantly associated with both developmental screening (adjusted rate ratio, 1.34; 95% CI, 1.13-1.57) and surveillance (adjusted rate ratio, 1.24; 95% CI, 1.08-1.42), representing an 8 to 9 absolute percentage point increase. State-level differences spanned 40 percentage points for screening (17.2% in Mississippi and 58.8% in Oregon) and surveillance (19.1% in Mississippi and 60.8% in Oregon), with approximately 90% of variation not explained by child and family characteristics. CONCLUSIONS AND RELEVANCE Despite more than a decade of initiatives, rates of developmental screening and surveillance remain low. However, state-level variation indicates continued potential for improvement. Systems-level quality improvement efforts, building on the medical home, will be necessary to achieve recommended screening and surveillance goals.
Ambulatory Pediatrics, 2008
BMJ Innovations
BackgroundChildren’s health and healthcare use are impacted by both medical conditions and social... more BackgroundChildren’s health and healthcare use are impacted by both medical conditions and social factors, such as their home and community environment. As healthcare systems manage a pediatric population, information about these factors is crucial to providing quality care coordination.MethodsThe authors developed a novel methodology combining medical complexity (using the Pediatric Medical Complexity Algorithm) and social complexity (using available family social factors known to impact a child’s health and healthcare use) to create a new health complexity model at both the population-level and individual-level. System-level data from Oregon’s Medicaid Management Information Systems and Integrated Client Services database was analysed, examining claims data and service utilization, to calculate the health complexity of children enrolled in Medicaid/Child Health Insurance Program (CHIP) across Oregon.ResultsOf the 390 582 children ages 0 to 17 enrolled in Medicaid/CHIP in Oregon fr...
PEDIATRICS, 2011
In 2006, the American Academy of Pediatrics recommended developmental screening of young children... more In 2006, the American Academy of Pediatrics recommended developmental screening of young children with a standardized screening tool as a routine component of well-child care. To assess the national and state prevalence of standardized, parent-completed developmental screening (DS-PC) in the previous 12 months and evaluate associations between screening and receipt of an early-intervention plan or mental health services for children at higher risk. Data from the 2007 National Survey of Children's Health were used. Nested t tests were used to compare each state to national prevalence. Logistic and multilevel regression models evaluated variations and associations with DS-PC. Nationally, 19.5% of children received a DS-PC in the previous 12 months, although the figure varied from 10.7% to 47% across the United States. Prevalence did not rise above 26.7% for any socioeconomic subgroup of children and was highest for younger, black, and publicly insured children and lowest for uninsured children and children with gaps in insurance coverage. Equally high-risk children varied twofold in their probability of receiving early intervention or needed mental health services according to whether they had received a DS-PC. There is a significant gap between the developmental screening that is recommended and what is reported nationally. When children are not screened consistently, opportunities for early identification, intervention, and treatment may be delayed. Gaps in screening and wide variations across states present considerable opportunities for cross-state learning to improve quality on this critical component of preventive pediatric care. Measurement systems for assessing prevalence and impact of screening require continued evaluation and development.
Ambulatory Pediatrics, 2008
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Papers by Colleen Reuland