Implementing the Promoting Healthy Development Survey (PHDS)

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Three new manuals provide comprehensive guidelines to state officials, physician practices, and health systems on how to implement the PHDS, a parent survey created with Fund support. The survey can be used to assess and improve the quality of preventive and developmental care provided to young children.

Organization: Child and Adolescent Health Measurement Initiative (CAHMI), Oregon Health & Science University

Target Population: Young children, ages 3 to 48 months

Useful for: Health care purchasers; pediatric clinicians; health systems; policymakers; families

The issue: Pediatric clinicians—who according to national guidelines should provide well-child care to children 12 times through three years of age—are in a good position to provide children with preventive and developmental services. Evidence shows that this care can make a difference in a child's brain development, social development, physical well-being, readiness for school, and ultimately, success in life. Most recommended preventive and developmental care is provided within the context of discussions between health care providers and parents. Parent surveys have been show to be the only reliable and valid method for assessing these communication-dependent aspects of care. Currently used measures such as the Health Plan Employer Data and Information Set (HEDIS) provide information about children' access to care—not the quality of care received.

The intervention: The Promoting Healthy Development Survey (PHDS), a parent survey created with Fund support, fills this gap by providing reliable and valid information. The PHDS can be used by health care providers, health systems, Medicaid agencies, and other stakeholders to measure and improve the quality of preventive and developmental care. The survey, given to parents of children ages 3 to 48 months, gauges the quality of preventive and developmental services by focusing on:

  1. anticipatory guidance and parental education given by a doctor or other provider;
  2. provision of health information;
  3. assessment of parental health and well-being;
  4. assessment of safety issues, including smoking, drug, and alcohol use in the family;
  5. assessment of parental concerns and follow-up with children at risk for developmental, behavioral, or social delays;
  6. family-centered care that promotes trust and partnerships with parents; and
  7. helpfulness and effectiveness of care provided.
The PHDS has been developed and tested to assess and report quality of care at four levels:
  • Health Plan. The original version of the PHDS was tested in three health plans to assess their performance in providing developmental services. Findings from the initial health plan study, and information about the reliability and validity of this measure, were published in Pediatrics in 2001 and can be found here.
  • State Survey. An enhanced version of the survey, known as PHDS-Plus, includes questions about child and parent health and health care utilization. To date, the PHDS-Plus has been implemented in nine states: Florida, Louisiana, Maine, Minnesota, Mississippi, North Carolina, Ohio, Vermont, and Washington. Findings about the quality of care provided to young children in three states can be found here.
  • Physician Office. The PHDS has also been validated for use in physician offices. A shorter version of the survey has been specifically developed for in-office administration. The provider-level survey can also be administered by mail or online and has been tested in practices in Vermont and North Carolina.
  • National survey. Several questions of the PHDS have been integrated into two national surveys—The National Survey of Early Childhood Health (NSECH) and the National Survey of Children's Health.

The PHDS surveys are based on guidelines created by the American Academy of Pediatrics and Maternal and Child Health Bureau Bright Futures program. As of March 2006, more than 30,000 surveys have been collected and analyzed. The health plan and population-based surveys are available in English and Spanish. Depending on the version, the PHDS can take from 10 to 25 minutes to complete. All of the surveys and implementation materials are available for free download.

Implementation: Researchers at CAHMI have created three manuals to help stakeholders implement, score, and report findings from the survey.

State Medicaid Agencies
One manual provides comprehensive guidelines on how to implement the PHDS. The primary audience for the manual is state Medicaid agencies, however it provides valuable information for health plans and providers as well. The manual walks users through the steps needed to develop an implementation strategy, prepare to conduct the survey, monitor its administration, construct quality measures, and report the findings. Drawing on lessons from the field, it provides templates and examples for survey implementation, including notification letters and other communications with families, sample interview text, and suggested timelines. It also provides scoring algorithms and other tools needed for data analysis.

Reduced-Item PHDS for Practices
Another manual provides information and advice for using the shorter version of the PHDS to measure health care quality at the level of individual health care practices. It includes implementation guidelines, templates for reporting results, parent interviews, and case studies.

Health Systems
A third manual offers detailed guidance on how to implement the PHDS in large health systems via mail. The manual provides a comprehensive look at the PHDS. In six steps, the authors review the purpose of the PHDS; how to plan for implementation; how to administer the survey; how to monitor administration and plan for data analysis; how to construct quality measures and analytic variables; and how best to report PHDS findings. Throughout the manual, CAHMI gives real-world examples and recommendations that are based on the organization's 10 years of experience with the PDHS.

For Further Information: Contact Colleen Peck Reuland, reulandc@ohsu.edu or visit the CAHMI website.

Updated December 2006

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Publication Date:
April 3, 2006