Quality of child healthcare in European countries: common measures across international databases and national agencies

Abstract

Background: The evaluation of child healthcare is not yet widely explored, especially from a cross-country comparison perspective. The routine adoption of measures by national assessment agencies is under-investigated. Though the guiding principles developed at international level call for a child-centric multi-dimensional evaluation of child care, its feasibility is hampered by the availability of robust and harmonized data.

Methods: To explore the data availability, international databases (IDBs) were scrutinized and measures dealing with child health-related issues were collated. In parallel, an ad hoc questionnaire was administrated to 30 Country Agents (CAs) to gather measures routinely adopted at local level. To facilitate the comparison of measures, a three-level conceptual map was developed.

Results: The IDBs yielded at 207 measures that pertained mainly to non-health determinants of health, whereas the 352 measures obtained from CAs focused on process and outcome. A set of 33 common measures that related to immunization, morbidity and mortality were identified.

Conclusions: A limited set of measures used both in IDBs and at national level identify common areas of concerns that certainly capture crucial issues with child prevention and health outcomes. However, they are far from satisfying a child-centric multi-dimensional approach to the evaluation of child well-being and well-becoming. There is room for improvement at both international and national levels. IDBs should include and harmonize measures that concern the provision of child-centric services and encompass physical, social and mental development. At the national level, efforts towards the inclusion of measures that concern non-health determinants of health should be pursued.

Figure 1

Map of the domains, categories and sub-categories Notes: In white, core sub-categories covered by both sources; in dark gray, sub-categories only covered by international databases; in light gray, sub-categories only covered by MOCHA countries. DALY, disability-adjusted life years; ICT, information and communications technology; LOS, length of stay; NEETs, not in education, employment or training; PREM, patient reported experience measure; PROM, patient reported outcome measure; PYLL: potential years of life lost; SEN, special education needs.