The development and testing of the CROSS Scale: An instrument to measure the ability of adolescent caregivers to recognize child illness severity

Health care costs in the United States represent more than 14 percent of the gross domestic product and now exceed 1 trillion dollars annually. The staggering costs that have continued to rise are the most influential factor in health care reform (Sultz & Young, 1999). Health care maintenance organizations and insurance providers have closely scrutinized utilizations of resources such as emergency care with efforts to restrict access through denial of payment when inappropriate resources are utilized. This trend in health care requires the health care consumer to not only identify the severity of the illness but to also identify safe, cost-effective management that would be within the guidelines of the health care insurer. Illness recognition is difficult for patients who have had little experience with illness management. Illness recognition and management are especially difficult for caregivers not directly experiencing the illness symptoms. They must rely solely on communication from the patient or their own assessment skills. Illness recognition can be a daunting task for new parents who have an infant or young child that is non-verbal and can not communicate. Adolescents with limited experience in child care are especially hindered in illness recognition skills.;The most recent statistics on emergency visits in the United States note slightly more than 93 million visits yearly (Ketsche, Custer, Gooden, Mosher, & Nopchinabutr, 2000). Approximately 50% of emergency department visits are considered non-urgent (L. Baker & Baker, 1994; MacLean et al., 1999). When patients seek health care in the emergency department for illnesses that can be managed by their primary health care provider, there are more than financial concerns. Care providers in the emergency setting are hard pressed for time to provide guidance on the topics of child care education including illness recognition and management.;The purpose of this study was to develop and examine the psychometric properties of the Caregiver Recognition of Symptom Severity (CROSS) Scale. This instrument was developed and tested specifically with an adolescent population.;Specific Aims. (1) Develop scenarios that adequately represent differing degrees of illness severity in children. (2) Develop common illness scenarios that are age and culturally appropriate for administration to a diverse adolescent population. (3) Conduct a pilot test of the newly developed instrument to measure the ability of adolescent caregivers to recognize child illness severity and appropriate management. (4) Revise and test the CROSS scale within an adolescent population. (5) Conduct the psychometric analyses of the CROSS scale. (Abstract shortened by UMI.)...