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  • Measure Summary
  • NQMC:000226
  • Jan 2002

Preventive screening and counseling on weight, healthy diet and exercise: average proportion saying "yes" to three items.

Bethell C, Klein J, Peck C. Assessing health system provision of adolescent preventive services: the Young Adult Health Care Survey. Med Care. 2001 May;39(5):478-90. [66 references] PubMed External Web Site Policy
Young adult health care survey. Version 2.0. Portland (OR): CAHMI - The Child and Adolescent Health Measurement Initiative; 1999 Feb 1. 8 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Clinical Quality Measure: Patient Experience

Description

This measure assesses the average proportion of "yes" responses to three items about whether provider(s) discussed/screened on weight, healthy diet and exercise among young adults.

Rationale

Health behaviors, such as alcohol use and drunk driving, sexual activity, depression, suicide, smoking, violence, and guns are the primary causes of morbidity and mortality among adolescents. Preventive counseling and screening on these and other health risk topics are the centerpiece of adolescent preventive services guidelines. Common components in adolescent preventive services guidelines set forth by the American Medical Association (AMA), American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and the U.S. Maternal and Child Health Bureau (MCHB) include:

  1. Periodic adolescent health care visits specifically focused on preventive screening and counseling.
  2. Private and confidential care whereby adolescents can meet privately with providers with assurances of confidentiality.
  3. Education and counseling on behavioral, emotional, and medical risks to health. This includes encouraging good health habits (e.g., healthy eating, physical activity) and providing guidance on avoiding risky behaviors (e.g. smoking, alcohol use, unprotected sexual activity, drunk driving, ignoring or reacting inappropriately to negative emotions, use of drugs, violence, and guns).
  4. Screening, early identification and referrals for behavioral, emotional, and medical risks. This includes screening for smoking, alcohol, sexual activity, depression, street drug use, involvement in or victim of violence or abuse, access to and use of guns, and unsafe practices such as infrequent helmet and seatbelt use or driving in a care with a driver who has been drinking alcohol.

Studies demonstrate that adolescents trust health care providers. Adolescents are interested and willing to talk with providers about recommended preventive counseling and screening topics, especially during private, confidential health care visits. Yet, for many reasons, including young adult access barriers to care and provider training and incentives, few adolescents receive recommended comprehensive preventive counseling and screening services on key topics such as alcohol use, depression, sexual activity, smoking, injury prevention, physical activity, and diet.

Among other strategies, performance measurement can be a powerful component of efforts to improve preventive services for adolescents. Experts and consumers emphasize the importance of adolescent preventive care as a top priority for health care system accountability and performance reporting, and point to the current lack of measurement methods. While the rate at which adolescents have yearly well-visits is being used by the National Committee for Quality Assurance (NCQA) as a national indicator of quality for health maintenance organizations, this measure provides no information about the provision of preventive counseling and screening nor takes into account the fact that preventive services are often provided outside the context of well-visits.

The Young Adult Health Care Survey (YAHCS) was developed to complement existing performance measurement methods. This 45-item survey was designed to provide a parsimonious, comprehensive and actionable assessment of adherence to adolescent preventive counseling and screening guidelines.

Evidence for Rationale

Bethell C, Klein J, Peck C. Assessing health system provision of adolescent preventive services: the Young Adult Health Care Survey. Med Care. 2001 May;39(5):478-90. [66 references] PubMed External Web Site Policy

Primary Health Components

Diet and exercise; screening; counseling

Denominator Description

The number of young adults age 14 years or older who answered at least two of three items in this scale for preventive screening and counseling on weight, healthy diet, and exercise

Numerator Description

Average proportion saying "yes" to three items

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Health behaviors, such as alcohol use and drunk driving, sexual activity, depression, suicide, smoking, violence and guns are the primary causes of morbidity and mortality among adolescents. The 1995 Youth Risk Behavior Surveillance Survey, a national survey of students in grades nine through 12, revealed that 72% of all deaths among school-aged youth were the result of four primary causes: motor vehicle accidents, other unintentional injury, homicide and suicide. Similar data from patients five to 21 years of age identified the same causes of mortality, indicating a need for physicians to focus on accidents and violence in preventive care.

Evidence for Additional Information Supporting Need for the Measure

Children Now's Managed Care & Adolescent Health Advisory Committee. Partners in transition: adolescent and managed care. Oakland (CA): Children Now; 2000 Apr. 68 p.

Grunbaum JA, Kann L, Kinchen SA, Ross JG, Gowda VR, Collins JL, Kolbe LJ. Youth risk behavior surveillance. National Alternative High School Youth Risk Behavior Survey, United States, 1998. J Sch Health. 2000 Jan;70(1):5-17. PubMed External Web Site Policy

Kann L, Kinchen SA, Williams BI, Ross JG, Lowry R, Hill CV, Grunbaum JA, Blumson PS, Collins JL, Kolbe LJ. Youth Risk Behavior Surveillance--United States, 1997. State and Local YRBSS Coordinators. J Sch Health. 1998 Nov;68(9):355-69. PubMed External Web Site Policy

National Center for Health Statistics. Advance reports of final mortality statistics, 1993. Mon Vital Stat Rep. 1996;44 (7 Suppl).

Ozer EM, Brindis CD, Millstein SG, Knopf DK, Irwin CE Jr. America's adolescents: are they healthy?. San Francisco (CA): University of California, San Francisco, National Adolescent Health Information Center; 1998.

Extent of Measure Testing

  • 1999: Five health plans and one professional review organization: CIGNA HealthCare (Southern California Branch), Blue Cross Blue Shield of the Rochester Area, Permanente Medical Group, San Francisco Health Plan, United Health Plan, and the Institute for Child Health Policy, as part of their Florida KidCare Evaluation efforts. The psychometric properties of the Young Adult Health Care Survey (YAHCS) measures of care were examined and confirmed to be sound.

    In-depth cognitive testing of the draft survey was conducted with 35 adolescents representing different socioeconomic groups, resulting in adjustments to the design, formatting, and wording of survey items. Readability analyses indicate that the YAHCS survey items are written at the 6th-8th grade reading level and cognitive testing confirmed the readability of the YAHCS across adolescents with a range of educational levels.

    YAHCS measurement scales demonstrated strong construct validity (mean factor loading = 0.64) and reliability (mean Cronbach's alpha = 0.77).

  • 2000-2001: Washington State Department of Health to assess for quality of care provided to adolescents enrolled in Medicaid in Snohomish County. Psychometric properties assessed and were confirmed again. Findings were similar to those shown by Bethell and colleagues.
  • 2002: New York State Department of Health to "pilot" the YAHCS for assessing quality of care in five chosen health plans. Psychometric properties assessed and were confirmed again. Findings were similar to those shown by Bethell and colleagues.

Evidence for Extent of Measure Testing

Bethell C, Klein J, Peck C. Assessing health system provision of adolescent preventive services: the Young Adult Health Care Survey. Med Care. 2001 May;39(5):478-90. [66 references] PubMed External Web Site Policy

Young adult health care survey (YAHCS) 2000 results, Snohomish County. Portland (OR): FACCT - The Foundation for Accountability; 2000. 42 p.

State of Use

Current routine use

Current Use

Collaborative inter-organizational quality improvement

External oversight/Medicaid

External oversight/Regional, county, or city agencies

External oversight/State government program

Internal quality improvement

Quality of care research

Measurement Setting

Ambulatory/Office-based Care

Hospital Outpatient

Managed Care Plans

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

To date the survey has been administered to young adults aged 14 to 19 years old

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Case Finding Period

12 months

Denominator Sampling Frame

Enrollees or beneficiaries

Denominator (Index) Event or Characteristic

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Time window precedes index event

Denominator Inclusions/Exclusions

Inclusions
Adolescents age 14 years or older who have been continuously enrolled in a health plan for 12 months (allowing for a one-month gap in enrollment) and who had a well visit or other type of preventive visit in the past 12 months, and who answered at least two of the three items in this scale.

Refer to the original measure documentation for further details.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Average proportion saying "yes" to three items

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Patient/Individual survey

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Items modified and improved from the adolescent questionnaire developed and tested by Jon Klein et. al., Klein JD, Craff CA, Santelli JS, et al. Developing quality measures for adolescent care: validity of adolescents' self-reported receipt of preventive services. Health Serv Research. 1999; 34:391-404.

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Composite/Scale

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

Preventive screening and counseling on weight, healthy diet and exercise.

Measure Collection Name

Young Adult Health Care Survey (YAHCS)

Submitter

Child and Adolescent Health Measurement Initiative - Nonprofit Organization

Developer

Child and Adolescent Health Measurement Initiative - Nonprofit Organization

Funding Source(s)

David and Lucile Packard Foundation, The Commonwealth Fund, and the Robert Wood Johnson Foundation

Composition of the Group that Developed the Measure

Christina Bethell, PhD, MBA, MPH; Colleen Reuland, MS

Financial Disclosures/Other Potential Conflicts of Interest

None

Adaptation

This measure was adapted from another source.

Date of Most Current Version in NQMC

2002 Jan

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Source(s)

Bethell C, Klein J, Peck C. Assessing health system provision of adolescent preventive services: the Young Adult Health Care Survey. Med Care. 2001 May;39(5):478-90. [66 references] PubMed External Web Site Policy

Young adult health care survey. Version 2.0. Portland (OR): CAHMI - The Child and Adolescent Health Measurement Initiative; 1999 Feb 1. 8 p.

Measure Availability

Sources available from the Child and Adolescent Health Measurement Initiative (CAHMI) Web site External Web Site Policy.

For more information, contact CAHMI at 615 N. Wolfe St, Room E4640, Baltimore, MD 21205; Phone: 410-955-1848; E-mail: info@cahmi.org; Web site: www.cahmi.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI on January 30, 2003. The information was verified by the Foundation for Accountability on February 19, 2003.

This NQMC summary was retrofitted into the new template on July 5, 2011.

The information was reaffirmed by the measure developer on April 8, 2016.

Copyright Statement

© CAHMI – Child and Adolescent Health Measurement Initiative, 2004.

This NQMC summary is based on the original measure documentation, which is subject to the measure developer's copyright restrictions.

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