Should healthcare organizations be accountable for child community health indicators at the community level?

Purpose of review: This paper reviews options for including community health accountability metrics for child healthcare systems, international and regional experience with such metrics, and some specific candidates for metric consideration.

Recent findings: The inclusion of community metrics in child health accountability systems requires expanded accountability frameworks and re-education of clinicians. Most of the experience with use of community metrics in accountability systems comes from international settings. Lessons learned in these settings include the importance of linking the metrics to various policy and practice implementation measures while balancing the incentives for such 'horizontal' or communitywide indicators with current incentives. The Accountable Communities for Health movement may be the best-known example of US community health indicators for accountability. Four new papers suggest specific child metrics for consideration as child metrics, but only infant mortality rates and high school graduation rates are sufficiently standardized and nationally reported to be useful for such efforts.

Summary: Healthcare accountability for child community health is an important next step, but the coordination with existing accountability systems, data collection systems, and financial incentives require more research to be effective in helping children. Infant mortality rates and high school graduation rates have the most potential as cross system accountability metrics.