Measuring health outcome in paediatrics: development of the RAHC measure of function.

Objective: To develop a genetic measure of health outcome (the RAHC Measure of Function) for paediatric health services.

Methodology: The RAHC Measure of Function (MOF) was modified from the Child Global Assessment Scale. The utility and reliability of the MOF was then tested by inter-clinician agreement on case scenarios, by inter-clinician agreement in outpatients, by parent-clinician agreement in outpatients and by responsiveness to change in acute admissions.

Results: The inter-clinician agreement on MOF ratings for case scenarios was moderately good, with an overall kappa of 0.42; P < 0.0001. Clinicians at respiratory and child psychiatry clinics nominated the same or adjacent MOF category to describe 100% (95% CI: 71.5-100) and 90% (95% CI: 68.3-98.8%) of 11 and 20 cases assessed, respectively. Parents nominated the same or adjacent MOF category as the attending clinician for 89.7% (95% CI: 72.7-97.8) and 82.9% (95% CI: 67.9-92.9) of 29 and 41 children in the same two clinics. Twenty-eight inpatient children had an MOF assessed on admission and discharge, and the median MOF score improved from 50.5 to 79 points (z = 4.53; P < 0.0001).

Conclusions: The MOF is easy to use and provides a valuable description of health outcome that parents are able to understand. The MOF is moderately reliable, is likely to be sufficiently reliable to compare groups of paediatric patients and is responsive to change.