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October 2018Vol. 19, No. 8Study Eyes Use of Electronic Health Records to Test Preventive Measures for Kids in Foster Care

While children in foster care generally have greater physical, developmental, and psychological needs than their peers, preventive health measures for these children are largely untested. A recent study in BMC Pediatrics describes a study on the feasibility of using electronic health records to determine appropriate preventive health guidelines for the youngest children in foster care, ages 0-3, and for adolescents, ages 12-18. These two age groups were chosen because of the range of well-care measures available for testing in both age cohorts. The study was designed to gauge the feasibility of gathering the data needed for calculating such health-care measures from electronic health records (EHR) or statewide automated child welfare information systems (SACWIS). Prospective measures of health-care quality included well-child visits, vaccinations, and the developmental screening of young children and adolescents in foster care.

The American Academy of Pediatrics' Recommendations for Preventive Pediatric Health Care served as a guideline for determining which measures to assess. Researchers reviewed the medical charts of children and adolescents from Nationwide Children's Hospital (NCH) in Columbus, OH, and corresponding SACWIS data from surrounding Franklin County. Criteria for inclusion included a requirement that the patient had been in foster care in Franklin County with at least one comprehensive well-care visit at a primary care or foster care specialty clinic at NCH. SACWIS data were matched with EHRs from NCH using social security numbers.

The study was conducted as part of the Children's Health Insurance Program Reauthorization Act Pediatric Quality Measures Program and focused on the following three points of time in child welfare management: entry into foster care, ongoing foster care, and a foster home change or exit. The study authors acknowledge that missing data proved to be a challenge, particularly with regard to foster care entry and exit dates.

The study concluded that it is not feasible to rely on independent data from either EHRs or a SACWIS to determine quality preventive measures for children in foster care. The authors explain that most of the proposed quality measures that were tested did not achieve "high adherence," as recommended under current guidelines, and note that it is not possible to say whether the missing data points explain the shortcoming. The authors conclude, however, that matching these two data sources at an individual level may provide the necessary complement of data to assess the quality of health care.

"Health Care Quality Measures for Children and Adolescents in Foster Care: Feasibility Testing in Electronic Records, by Katherine J. Deans, Peter C. Minneci, Kristine M. Nacion, Karen Leonhart, Jennifer N. Cooper, Sarah Hudson Scholle, and Kelly J. Kelleher (BMC Pediatrics, 2018), is available at (347 KB).