Measuring quality of care for vulnerable children: challenges and conceptualization of a pediatric outcome measure of quality.

This article addresses conceptual and practical issues in the assessment of pediatric health care quality, outlines a conceptual model for measuring quality, and describes ongoing research to validate an outcome measure of health care quality for vulnerable children. Pediatric quality measurement is distinct from that for adults due to development, dependence, differential epidemiology, demographic factors, and differences between the child and adult health services systems. A noncategorical approach to quality measurement, rather than one based on illness status or specific condition, is necessary to adequately measure quality for the majority of children, both healthy and ill. One promising noncategorical measure of pediatric health care quality is health outcome, specifically health-related quality of life (HRQOL). The Pediatric Quality of Life Inventory (PedsQL), a brief, practical, reliable, valid, generic pediatric HRQOL measure, is a suitable candidate measure. Ongoing research to validate the PedsQL as an outcome measure of health care quality is described.