Measuring the impact of medical care on children.

To assess the impact of medical care on children we have developed a conceptual model based on both theoretical considerations and empirical research. Child health is viewed as the ability to participate fully in developmentally appropriate activities and requires physical, psychological, and social energy. The medical system influences health through interventions addressing these domains. Many methodologic issues are unique to the measurement of medical care processes and outcomes for children. Problems in measuring the process of medical interviews include developing systems that capture the dynamics of interactions, assess the cognitive appropriateness and metaphorical interpretation of language, and reflect the emotional impact of certain incidents. Issues that confound measurement of children's views include position bias, acquiescence response bias, and limited understanding of negatively worded items. Further, the concordance between parent and children reports or health constructs varies widely, which suggests the need to include children's reports to obtain a comprehensive view of their health.