The Promoting Healthy Development Survey

Vision of the PHDS


The Promoting Healthy Development Survey (PHDS) was designed to measure the communication-dependent aspects of care – what providers and parents discuss at the visit. The PHDS not only assesses whether recommended care is provided, but also the degree to which parents have their informational needs met and whether the care provided is family centered. These are the aspects of quality care that are best measured by asking parents directly.

The PHDS collects data in the following domains:

  • Anticipatory guidance and education for parents– measures whether parents’ information needs were met with regard to age-specific topics based on AAP Guidelines.
  • Developmental surveillance– assesses whether the provider asked about and addressed parents’ concerns about their child’s learning, development and/or behavior.
  • Developmental screening– determines whether standardized screening tools for developmental and behavioral delays were used.
  • Follow up for children at risk– measures whether children at risk were referred and/or received follow-up services.
  • Assessment of psychosocial well-being and safety in the family– assesses whether providers asked about parents’ emotional and mental well-being, as well as smoking, alcohol and drug abuse, and physical safety in the home.
  • Family-centered care– measures whether providers interact with the family in a respectful manner, engage the parent as a partner in care, and listen to and address parents’ concerns.


The PHDS also gathers information useful for describing the population served and determining their health care needs. This includes measures of:

  • Children’s health care utilization– to determine rates of routine or ER visits.
  • Access and care coordination– to monitor problems with access to pediatric care and coordination among providers.
  • Children’s health status– to assess rates of children at risk for developmental and behavioral delays, special health care needs, and overall health status.
  • Parenting to optimize development– to assess the proportion of parents reading to young children, applying injury prevention measures, or experiencing depression.

Development and Testing of the PHDS


The PHDS has been used since 1998 by health care systems and health care providers to assess the quality of health care they provide to young children. The PHDS has been used at the national, state, health plan, practice, and provider level. Over 45,000 surveys have been completed by parents, which have been used to improve the quality of health care provided to young children. Additionally, items from the PHDS have been included in national surveys such as the National Survey of Early Childhood Health (NSECH) and the National Survey of Children’s Health (NSCH). The PHDS was endorsed by National Quality Forum (NQF) in 2008.

See this article for a full description of the development of the PHDS: Bethell C, Reuland C, Schor E. Assessing health system provision of well-child care: The Promoting Healthy Development Survey. Pediatrics. 2001 May; 107(5):1084-94.

See this article for a description of the PHDS quality measures: Bethell C, Reuland C, Halfon N, Schor EL. Measuring the quality of preventive and developmental services for young children: national estimates and patterns of clinicians' performance. Pediatrics. 2004 Jun;113(6 Suppl):1973-83.

Links to National Surveys and Measurement Clearinghouses


National Quality Forum. The Promoting Healthy Development Survey (PHDS) was endorsed by the National Quality Forum as a valid measure for system, plan and provider-level assessment of patients’ experiences with preventive and developmental health care in 2008.

Agency for Healthcare Research & Quality (AHRQ) National Quality Measures Clearinghouse (NQMC). The measures derived from the Promoting Healthy Development Survey (PHDS) are included in the AHRQ-NQMC. Click here to find more information about each of the measures at the AHRQ.

National Survey of Early Childhood Health (NSECH). The NESCH, conducted in 2000, interviewed the parents of over 2,000 children under 3 years old about their experiences receiving pediatric care and about the promotion of children’s health in their homes. The survey, which provides national baseline data on pediatric care, includes items from the PHDS. Click here to learn more about the NESCH.

National Survey of Children’s Health. The NSCH, conducted annually as of 2016 is a national survey that provides a broad range of information about children’s health and well-being collected in a manner that allows for comparisons between states and at the national level. The survey includes items from the PHDS. Click here to learn more about the NSCH.