Pediatric Outcomes: can we agree?

Discussions on value-based care often grapple with the concept of 'value,' which is frequently met with skepticism. The crux of the matter lies in defining 'outcomes' in the value equation: value = outcomes/cost. Without consensus on what we aim to achieve, it's challenging to gauge our progress effectively.

Quality metrics, while necessary, predominantly reflect processes rather than outcomes. Though they can correlate to outcomes, the relationship is sometimes tenuous, with the potential for manipulation to meet 'metrics' without truly improving outcomes.

Therefore, the question arises: Can we reach an agreement on what the desired outcomes should be? As we delve deeper into discussions of value, it's crucial to shift our focus toward tangible outcomes rather than merely metrics.

I suggest we initiate our exploration of pediatric value by examining the work of the Annie E. Casey Foundation. For those unfamiliar, here's a brief overview:

The Annie E. Casey Foundation's KIDS COUNT Data Book adopts a comprehensive approach to assess child well-being through a set of health indicators, reflecting a multifaceted evaluation of health outcomes for children and teens across the U.S. These indicators include the rate of low birth-weight babies, the extent of children's health insurance coverage, mortality rates among children and teens, and the prevalence of obesity in the youth—all crucial public health concerns.

These health metrics are part of a broader set of 16 key indicators grouped into four domains—Economic Well-Being, Education, Health, and Family and Community—that collectively depict child well-being in each state. Here's a distilled summary:

Economic Well-Being

1. Children in Poverty: The number of children living in poverty conditions.
2. Children Whose Parents Lack Secure Employment: The number of children with parents who do not have regular, stable employment.
3. Children Living in Households with a High Housing Cost Burden: The number of children residing in households where a significant portion of the family's income is spent on housing costs.
4. Teens Not in School and Not Working: The number of teenagers who are neither enrolled in school nor participating in the labor market.

Education

1. Young Children Not in School: The number of children ages 3 and 4 who are not attending preschool or kindergarten.
2. Fourth-Graders Not Proficient in Reading: The proficiency levels of fourth-grade students in reading, indicating the percentage that did not meet the proficiency standard.
3. Eighth-Graders Not Proficient in Math: The proficiency levels of eighth-grade students in mathematics, indicating the percentage that did not meet the proficiency standard.
4. High School Students Not Graduating On Time: The percentage of high school students who do not graduate within the expected time frame.

Health

1. Low Birth-Weight Babies: The number of babies born with a low birth weight.
2. Children Without Health Insurance: The number of children under the age of 19 without health insurance coverage.
3. Child and Teen Deaths per 100,000: The mortality rate of children and teenagers.
4. Children and Teens Who Are Overweight or Obese: The percentage of children and teenagers between the ages of 10 and 17 who are overweight or obese.

Family and Community

1. Children in Single-Parent Families: The number of children living in single-parent households.
2. Children in Families Where the Household Head Lacks a High School Diploma: The number of children living in households where the head of the household does not have a high school diploma.
3. Children Living in High-Poverty Areas: The number of children residing in areas with high rates of poverty.
4. Teen Births per 1,000: The number of births per 1,000 female teenagers aged 15-19.

These domains guide policymakers, researchers, and the public in pinpointing where interventions can be most effective.

State rankings are crafted by standardizing and summing scores across these domains. The Foundation's method involves:

1. Standardizing scores for the 16 indicators.
2. Summing these scores within their respective domains to create a domain score.
3. Calculating a total score that reflects overall child well-being.
4. Weighting each measure equally to provide a balanced assessment.
5. Ranking states from highest to lowest based on their total standard score.

This equitable methodology ensures that each indicator contributes fairly to the assessment of child well-being, providing a comprehensive comparison across states and highlighting both successes and areas for improvement.

In light of this framework, the KIDS COUNT Data Book's state rankings could serve as a solid foundation for our discussions. Despite the general aversion to rankings, these particular rankings emerge as one of the least biased, focusing on overall child well-being and incorporating key factors beyond health.

Here is the full report..