Series contains files pertaining to assessment tools created by Starfield, including the Child Health and Illness Profile (CHIP), the Primary Care Assessment Tools (PCAT), and adjusted clinical groups (ACG).
Barbara Starfield was central to the development of Ambulatory Care Groups (ACGs) that is used worldwide for measuring morbidity burden of patient populations based on disease patterns, age, and gender. The ACG system provides a more accurate representation of the morbidity burden of populations, subgroups or individual patients. ACGs improves accuracy and fairness in assessing provider performance, predicting patients’ use of healthcare, and in setting fair payment rates.
The impetus for the research which ultimately became the ACG System was spurred on by an observation that morbidity tends to cluster. The occurrence of disease is not randomly distributed across a population but tends to “cluster” or affect some individuals more than others. Furthermore, multiple seemingly unrelated diseases tend to “cluster” in the same individual. The idea is that the same set of risk factors may cause more than one disease. The JHU ACG team’s research findings supported the hypothesis that clustering of morbidity is a better predictor of health service resource use than the presence of specific diseases.” This emphasis on clustering of morbidity differentiates the ACG system from other case-mix adjustment methodologies that tend to focus on specific diseases, diagnoses, procedures, physiology, or medical use.
Starfield was a researcher in the Ambulatory Morbidity Groups Project, a federally sponsored study designed to develop and validate a case-mix methodology. Case mix refers to situations in which one group of patients or beneficiaries are not comparable to another in terms of their need for health services. “The approach, known as the Ambulatory Morbidity Group (AMG) system is meant to provide a statistically valid clinically relevant measure useful in predicting the need for ambulatory health services. It is based on the premise that measure of illness burden will be useful in explaining variation in health care resource consumption.” [source, “paper to be presented at the 1988 Group health Institute”]
ACG materials include notes; research data, including statistics; charts; papers to be presented at conferences, completed grant applications; and summary statistics from schools.
[Folder 4.1.001 - 4.1.003] Ambulatory Medical Groups--1985-1989 (AMG), Precursor of ACG system (JHU) AMG (Grant) Consultants 1989, Forms RD-RM [?]. — 1983;1985-1987;1989. — 3 folders
The Child Health and Illness Profile (CHIP) is a self-administered questionnaire (survey) developed to assess the health status and health-related behaviors of youth ages 6-17. At the time of the CHIP study, there was no reliable, comprehensive, and easily administered test of child health status with which to evaluate health services for children. Existing tools had shortcomings, for instance, there was a need for a measure that used child-relevant characteristics rather than adult-relevant characteristics. Barbara Starfield, Anne Riley, and their colleagues at the Johns Hopkins School of Hygiene and Public Health developed a multi-dimensional child health status instrument. The research was funded by the Bureau of Maternal and Child Health (U. S. Department of Health and Human Services), The Henry J. Kaiser Family Foundation, AHCPR, the Agency for Health Care Policy and Research. The health status measure encompasses a wide variety of aspects of child health including preventive and health promoting characteristics. CHIP can be used to assess the potential for resilience, risk, future health and achievement. Over a twelve-year period researchers developed both Adolescent and Child Editions of CHIP. Over 5,000 children and adolescents from ethnically and socio-economically diverse families throughout the U.S. and Spain participated in the study.
Purpose of CHIP-AE: to document health status of children and adolescents broadly conceived; to identify differences across population subgroups; and to evaluate the impact of health services on health. SCHIP refers to State-CHIP [Source: Barbara Starfield Collection, transparencies box 10]
Researchers also produced an annotated bibliography on Child Health Status Measures. Starfield headed the CHIP Adolescent Survey Team. Other researchers on the team included a sociologist with an expertise in longitudinal research on child and adolescent social functioning; a psychologist; an adolescent medicine pediatrician; a health services researcher; and a data analyst. They include: Anne Riley, Sheryle Ryan, Bert Green, Marilyn Bergner, Margaret Ensminger, and Kelly Vogel (project coordinator).
Materials cover different phases of the research including the planning and pilot phase that contains focus group and pre-test materials and feedback on CHIP by colleagues. Materials include journal articles co-authored by Starfield; annotated bibliography on child health status; budget files, correspondence with potential survey sites including schools, school systems, and health facilities, as well as with research colleagues; research data and data analysis; grant proposals; introductions to the project; lists of researchers; CHIP team meeting agendas, minutes, and other related materials; notes; personnel files; project activities summaries; reports from schools (Includes three Adolescent Health Survey reports summarizing the results of the CHIP Survey administered at schools in the Fall of 1992); reviews of the proposed study; summary statistics from schools; blank survey forms; tables; form letters and instructions for conducting the surveys and analyzing the data; and scripts for administering the survey.
[Folder 4.2.029] [Starfield Notes on Kaiser Family Foundation Grant to Support 1st and 2nd Stages of Development of the CHIP (Child-including adolescent) Health and Illness Profile]. — 2007. — 1 folder
[Folder 4.2.056 - 4.2.063] CHIP-CE and -AE (Adolescent Health) Agency for Health Care Policy and Research (AHCPR); William T. Grant Foundation, MCH [?] Grant proposals 1991-1992 and 1996-2000. — 1989-1992;1994-1997. — 1 folder
The Primary Care Assessment Tool, PCAT, was a survey developed to assist state agencies in assessing the current system of primary care at a statewide level. The objective of the assessment was to use the results as a guide in developing goals and strategic planning initiatives for primary care system development. The tool was developed from Starfield’s model that incorporated attributes of primary care that could be defined and measured.
Starfield identified four ways of measuring primary care: first contact, which refers to the primary care provider facilitating entry into the health services system including provision of services that are accessible and available and utilization of those services when a need for care arises; longitudinality, or use of one provider over time; comprehensiveness, or providing a broad range of services; and coordination of services wherein the provider acts as the coordinator of treatment plans for the various aspects of patient care. The assessment also looks at family orientation, community orientation, and cultural competence, or promoting effective care in cross-cultural situations. The assessment includes four facets of evaluation: resource capacity, services delivery, clinical performance, and outcomes. [Source: Barbara Starfield, transparencies, box 10]
PCAT was produced by The Child and Adolescent Health Policy Center of the School of Hygiene and Public Health Department of Maternal and Child Health.
Materials include correspondence; early versions of the tool; blank survey questionnaires, annotated drafts of surveys; (versions include: Consumer/Client Telephone Survey; Provider Survey; Facilities Survey; adult survey; child survey; surveys in other languages, including Spanish); papers; transparencies and printouts used for presentations; completed human subjects committee forms; research proposals; grant applications; research data; instructions on analyzing research data; published articles; meeting agendas and minutes; and reports.
Research project titles include: “Child Health Systems Primary Care Assessment”; “Consumer Experiences and Provider Perceptions of the Quality of Primary Care: Implications for Managed Care” (“A study to determine the extent to which consumer and provider reports of primary care differ according to particular characteristics of the primary care setting”); “Development of Instruments to Measure Primary Care”; “Evaluating Primary Care Services for Low-Income Children in Fee-for-Service vs. managed Care Settings”; “A study to assess the experiences of a disadvantaged population of children in receiving primary care, and to determine whether certain types of organizations provide better primary care to these populations”; “Primary Care Assessment Tool for the Development of a Comprehensive Primary Care System for All Children”; “Primary Care for Children Needs Assessment Surveys”; “Validating the Adult Primary Care Assessment Tool”