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Initial Core Set of Children's Healthcare Quality Measures

Identification of Initial Core Set of Measures for Voluntary Use by Medicaid and Children's Health Insurance Program (CHIP) Programs

Summary Report

Core set recommended by the AHRQ National Advisory Council Subcommittee on Children's Healthcare Quality Measures for Medicaid and CHIP Programs, September 18, 2009

This summary presents a brief overview of the processes used to recommend an initial core set of children's health care quality measures to the Agency for Healthcare Research and Quality (AHRQ) National Advisory Council on Healthcare Research and Quality, the measures recommended, and next steps to be taken by AHRQ and the Centers for Medicare & Medicaid Services (CMS).

Background

Title IV of the Children's Health Insurance Program Reauthorization Act (CHIPRA; Public Law 111-3; February 3, 2009) called for the Secretary of the U.S. Department of Health and Human Services (HHS) to identify an initial core set of children's health care quality measures to be posted for general comment by January 1, 2010 (Section 401(a)). In April 2009, the AHRQ and CMS signed a Memorandum of Understanding giving AHRQ leadership responsibilities for identifying the initial core set, working in very close partnership with CMS which has the authority for implementation of all CHIPRA provisions.

As part of their effort to use a transparent and evidence-based process for identifying an initial core set of pediatric quality measures for voluntary use by Medicaid and CHIP Programs to be posted for general comment by January 1, 2010: CMS and AHRQ asked the AHRQ National Advisory Council on Healthcare Research and Quality (NAC) to establish a time-limited Subcommittee on Children's Healthcare Quality Measures for Use by Medicaid and CHIP programs (SNAC). The SNAC was asked to hold public meetings and was charged with developing criteria for identifying core measures, applying those criteria to measures in use or otherwise nominated for consideration, and making recommendations to the NAC. The NAC in turn provides advice to the Director, AHRQ, and to the Secretary, HHS. For more information on the public SNAC meetings and overall process for identification of the initial core measure set, other CHIPRA quality activities, a link to CMS CHIPRA activities, and a link to Public Law 111-3, visit http://www.ahrq.gov/chip/chipraact.htm.

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SNAC and the Public Process

The SNAC met for the first time in July 2009 to discuss and further refine a SNAC-developed modified Delphi process to score measures known to be in use by Medicaid and CHIP programs on validity, feasibility, and importance. The SNAC also agreed to try to recommend a core measure set no greater than 25 measures. The SNAC report to the NAC in July 2009 is available at http://www.ahrq.gov/chip/chipraact.htm.

By mid-October 2009, the SNAC had 121 measures to consider during a second modified Delphi process. These 121 measures included measures that:

Had passed criteria for validity, feasibility, and importance at the July SNAC meeting.
Were deemed to be in need of additional information at the July SNAC meeting.
Had been nominated by SNAC members, members of the public, or members of the CHIPRA Federal Quality Workgroup or identified through continuing environmental scans.

Public nominators included members of the Medicaid Medical Directors Learning Network, the Medical Association's Physician Consortium for Performance Improvement (PCPI), the National Partnership for Women and Families, and additional nominations obtained through E-mail to an AHRQ address. CHIPRA Federal Quality Workgroup nominations came from CMS and the Health Resources and Services Administration (HRSA). Papers by CHIPRA contractors also recommended measures for consideration.

Using a second modified Delphi scoring process in early September, SNAC members selected 65 of the 121 measures as meeting criteria for validity, feasibility, and importance. At the September 17-18, 2009 SNAC meeting, several measures that did not strictly pass the second Delphi round (e.g., validity scores of 6 or 6.5 rather than the cutoff of 7) were added to the list of measures to be discussed and voted on during the meeting. An example was adolescent well-care visits.

In addition, during the September 17-18, 2009, SNAC meeting, the SNAC voted to combine some measures and consider them to be single measures for purposes of further SNAC voting. For example, three well-child care visits were combined into one measure for voting purposes (shown as PHP-9 on the SNAC recommendation table); and the Consumer Assessment of Healthcare Providers & Systems (CAHPS®) surveys for children with and without special health care needs were combined into the voting category FEC-1/FEC-5.

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Recommendations

Through a series of discussions followed by a series of votes over the day and a half meeting, the SNAC agreed to recommend to the NAC 25 measures for the initial core measure set. (Table 1).

The SNAC-recommended set of measures will next be discussed by the Children's Health Insurance Program Reauthorization Act (CHIPRA) Federal Quality Workgroup and reviewed by Medicaid and CHIP officials. Subsequently, a CMS-AHRQ-recommended initial core set will be forwarded to the Secretary, HHS, for her consideration and then to the Office of Management and Budget (OMB) for its review, before a final recommended set of measures is posted for general comment, by January 1, 2010.

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Important Considerations

It is important to note that the SNAC did not recommend that the measures on the list be implemented "as is." Rather, the measure denominators should be respecified so that they are feasible for use across all Medicaid and CHIP programs and by providers, consumers, and intermediaries (e.g., health plans contracting with State Medicaid programs). For example, HEDIS CAHPS® (FEC 1 and 5) (Healthcare Effectiveness Data and Information Set/Consumer Assessment of Health Plans and Providers) as currently specified are currently used primarily by Medicaid managed care health plans that report to the National Committee for Quality Assurance (NCQA). The SNAC recommended that in the future, the CAHPS® instruments be used by all Medicaid and CHIP programs so that family experiences of care across a broader spectrum of covered children can be understood, compared, and when needed, acted upon. Similarly, few of the measures are used to report data that distinguish care quality by race, ethnicity, socioeconomic status, or special health care need status among children. In the future, consistent with the CHIPRA legislation, data should be collected so that meaningful comparisons can be made between children with and without special health care needs and among children of varying racial and ethnic identities.

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Next Steps

The SNAC-recommended set of measures will next be discussed by the CHIPRA Federal Quality Workgroup on September 23, 2009, and reviewed by Medicaid and CHIP officials in a CMS listening session on September 29, 2009, and at other venues. Subsequently, a CMS-AHRQ-recommended initial core set of measures will be forwarded to the Secretary, HHS, for her consideration, and then to the White House Office of Management and Budget for its review, before posting a final recommended set for general comment, by January 1, 2010.

Public comments on the process of identifying the initial core measure set for voluntary use by Medicaid and CHIP programs are continuously invited via the E-mail address at http://www.ahrq.gov/chip/chipraact.htm.

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Table 1. SNAC-recommended initial core set of children's healthcare quality measures, in priority order by number of SNAC votes, September 17-18, 2009

Control Number	Measure Label	SNAC Voting Results				Validity, Feasibility, Importance Scores*
Control Number	Measure Label	1st Place Votes	2nd Place Votes	3rd Place Votes	Sum of Votes	Median V	IQR	N	Median F	IQR	N	Median I	IQR	N
PHP-5	Immunizations for 2-year-olds	19	3	0	63	8	7-9	19	8	7-9	19	8	8-9	19
PHP-2	Frequency of ongoing prenatal care (NCQA measure)	13	6	3	54	7	6-7	19	6	5-7	19	6	6-8	19
AC-10	ER utilization—Average number of emergency room visits per member per reporting period	13	5	5	54	7	6-8	19	7	6-8	19	7	6-8	19
CC-19	Annual number of asthma patients (>1 year-old) with >1 asthma-related ER visit	11	7	6	53	7	6-7	19	6	5-7	19	6	6-8	19
PHP-19A	BMI 2—18 years old (NCQA and nominated by CMS)	11	7	5	52	7	6-7	17	7	6-7	17	7	5-7	17
PHP-9	Well-child visits—SNAC voted to combine three NCQA measures: 1) WCVs in the first 15 months of life; 2) WCVs in the third, fourth, fifth and sixth years of life; 3) Adolescent Well Care Visits	16	1	0	50	7	5-8	19	6	4-7	19	6	5-7	19
PHP-43	Total eligibles receiving preventive dental services (EPSDT measure Line 12B)	12	6	1	49	7	5.5-8	12	8	6.5-8	12	7	6-8	13
PHP-6	Adolescent immunization	10	6	3	45	8	7-9	19	8	7-9	19	8	8-9	19
FEC-5 &1	(SNAC voted to include children with and without chronic health conditions) HEDIS CAHPS 4.0 a. Patient Experiences with Prescription Medicine Composite b. Parent's Experiences with Getting Specialized Services c. Family Centered Care Composite d. Parent Experiences with Coordination of their Child's Care Composite	11	3	5	44	7	7-8	19	7	6-8	19	8	7-9	19
PHP-1	Timeliness of prenatal care (NCQA measure)	10	4	5	43	7	6-8	19	7	6-8	19	7	6-8	19
PHP-26A	HRSA MCH Health Status Indicator #01A—% of live births weighing < 2,500 grams	8	8	3	43	7	6-8	19	8	7-8	18	8	6-9	19
PHP-33	Rates of screening using standardized screening tools for potential delays in social and emotional development (ABCD)	10	4	5	43	7	5-7	19	8	7-8	19	7	5-8	19
CC-2	Follow-up care for children prescribed attention-deficit/hyperactivity disorder (ADHD) medication (continuation and maintenance phase)	9	3	6	39	7	5-8	19	7	6-7	19	7	6-7	19
PHP-22	Annual dental visit (NCQA measure)	7	6	3	36	7	6-8	19	8	7-8	19	7	7-9	19
CC-29	Child and adolescent Major Depressive Disorder (MDD)—suicide risk assessment	5	8	5	36	7	7-8	19	7	6-8	19	8	7-8	19
CC-13	Annual hemoglobin A1C testing (all children and adolescents diagnosed with diabetes)	7	5	5	36	7	7-8	19	7	6-8	19	7	7-8	19
CC-5	Follow up after hospitalization for mental illness	7	5	2	33	7	6-8	19	7	5-7	19	7	7-8	19
PHP-12	Chlamydia screening 16-20 females (NCQA)	5	5	5	30	7	5-7	19	7	5-7	19	8	5-9	19
PHP-38	Cesarean Rate for Low-risk First Birth Women	5	4	5	28	7	5-8	19	6	4-7	19	6	5-7	19
FEC-6	Use of Clinician & Group primary care CAHPS survey for practitioners participating in Medicaid and CHIP	6	3	4	28	7	6-7	19	6	4-7	19	7	6-8	19
AS-1	Access to primary care practitioners, by age and total.	8	0	4	28	6	4-7	19	7	6-8	19	7	4-8	19
AC-3	Total EPSDT eligibles who received dental treatment services (EPSDT CMS Form 416)	3	5	7	26	7	6-8	19	8	7-8	19	7	7-9	19
AC-4	Pediatric catheter associated blood stream infection rates (ICU and high risk nursery patients)	6	2	4	26	7	5.5-8	12	8	6.5-8	12	7	6-8	13
AC-2	Pharyngitis—appropriate testing (NCQA measure)	2	5	4	20	8	7-8	19	7	7-8	19	7	5-7	19
AC-17	OME—systemic antimicrobials—avoidance of inappropriate use	4	2	4	20	7	6-8	19	7	6-7	19	7	5-8	19

SNAC Voting: 1st place votes receive 3 points; 2nd place votes receive 2 points; 3rd place votes receive 1 point. Sum of votes = sum of points awarded. Rank ordered here by total number of points awarded. Thus, 25 measures were recommended by the SNAC.

*Key: V=Validity F=Feasibility I=Importance IQR=Inter-Quartile Range N=Number of Subcommittee members rating measure.

Table 2. Measures that Passed Delphi II but Were Not Chosen as Recommended Measures by SNAC Voting, September 18, 2009

Control Number	Proposed Core Measure Label
Prevention and Health Promotion
*Prenatal/Perinatal*
PHP-3	Smoking Cessation and Prevention: Pregnant women
PHP-26B	HRSA MCH Health Status Indicator #01B—% of live singleton births weighing less than 2,500 gms
PHP-26C	HRSA MCH Health Status #02A—% of live births weighing less than1500 gms
PHP-26D	HRSA MCH Health status #02B—% of live singleton births weighing less than 1500 gms
PHP-31	MCHB National performance measure #8—the rate of birth (per 1,000) for teenagers aged 15-17 years
PHP-32	Proportion of infants 22-29 weeks gestation treated with surfactant who are treated within 2 hours of birth
PHP-34	Health systems capacity indicator #04-% of women 15-44 with a live birth during the year whose observed to expected prenatal visits are greater than or equal to 80% on the Kotelchuck Index
PHP-36A	Rate of elective delivery prior to 39 completed weeks gestation
*Immunizations*
PHP-5B	Two-year-old Immunization Measure—Assessing immunizations by timeliness and the ACIP/AAP/CDC schedule versus HEDIS dose counting (OR)
*Social/Behavioral Health Screening*
PHP-33A	Administration of SDBS (Standardized screening tools social and emotional (CMWF/CAHMI))
*Dental/Oral Health*
PHP-42	Total eligibles receiving any dental services (EPSDT measure Line 12A)
PHP-43A	HRSA Oral Health Measures WG Measure—% of children age 12-72 mos with 1 or more fluoride varnish apps documented
*General Screening*
PHP-17	Newborn Hearing Screening
PHP-18	Vision screening—use MEPS description and performance data
Management of Acute Conditions
*Acute Upper Respiratory Tract Illness*
AC-1	Upper respiratory infection—appropriate treatment
*Acute Otitis Externa*
AC-11	Acute Otitis Externa—Topical therapy
AC-13	Acute Otitis Externa—Systemic antimicrobial therapy-avoidance of inappropriate use
*Otitis Media with Effusion*
AC-14	OME Diagnostic evaluation—assessment of tympanic membrane mobility
AC-18	OME—systemic corticosteroids—avoidance of inappropriate use
*Inpatient Care*
AC-26	AHRQ Pediatric Quality Indicator Composite Measure (Patient Safety Composite)
*Dental*
*Inpatient Care*
AC-5	Foreign body left after procedure (PDI 3)
AC-6	Iatrogenic pneumothorax in non-neonates (PDI)
AC-20	Care transitions—transition record with specified elements received by discharged patients—Inpatient
AC-23	Central line associated bloodstream infection (PDI 12)
AC-24	Accidental puncture and laceration
AC-25	Decubitus ulcer
*ED Care*
CC-1	Followup care for children prescribed attention-deficit/hyperactivity disorder (ADHD) medication (Initiation Phase; NCQA measure)
*HIV*
CC-8A	HIV/AIDS Bureau quality performance measure—percentage of clients with AIDS who are prescribed HAART
CC-23	HIV AIDS Bureau Measure—% of clients with HIV infection who had two or more CD4 T-cell counts performed in the measurement year
CC-24	HRSA HIV/AIDS QPR % of clients with HIV who had two or more medical visits in an HIV setting in the measurement year
*Asthma*
CC-10	Asthma — appropriate medications
CC-10B	Use of Appropriate Medications for People 5-20 years of age with Asthma – Average number of member controller months
CC-18	Annual influenza vaccination (all children and adolescents diagnosed with asthma)
CC-20	Annual number of asthma patients (>1 year old) with >1 asthma-related hospitalization
*Diabetes*
CC-14	Annual lipid profile (adolescents with diabetes >16 years old)
CC-16	Annual eye examination (adolescents with diabetes >16 years old)
CC-17	Annual influenza vaccination (all children and adolescents diagnosed with diabetes)
*End-Stage Renal Disease*
CC-33	Pediatric end-stage renal disease—Plan of care for inadequate hemodialysis
CC-34	Pediatric end-stage renal disease—influenza immunization
*Duration of Enrollment*
D-2	Retrospective duration measure

Table 3. Measures That Did Not Meet Thresholds for Delphi II Scoring on Validity, Feasibility, and Importance

Control Number	Measure Label	Median V	IQR	N	Median F	IQR	N	Median I	IQR	N
Prevention and Health Promotion
*Prenatal/Perinatal*
PHP-1A	HRSA MCH MPR #18—% of infants born to pregnant women receiving prenatal care beginning in the first trimester (data source — nvss—differs from NCQA; Medicaid/CHIP specific not available from NVSS.	5	5-7	17	5	5-7	17	6	5-8	17
PHP-26	Percentage of low birth weight (PDI —hospital discharge data)	6.5	5-7	18	7	6-8	18	7	6-7	18
PHP-27	Postpartum care visit NCQA measure	6	5-7	18	7	5-7	18	6	5-7	18
PHP-30	MCHB National performance measure #17—percent of VLBW infants delivered at facilities for high-risk deliveries and neonates	6	4.5-7	16	6	5-7	15	5	5-7	15
PHP-30A	Under 1500g infant Not Delivered at Appropriate Level of Care	5	3-5	18	5	3-5	18	5	5-7	18
PHP-36	Elective delivery prior to 39 weeks gestation	6	4-7	14	6	5-7	14	5	4-7	14
PHP-40	HRSA MCH NPR MEASURE #11—% of mothers who breastfeed their infants at 6 mos of age	6	5-6	18	5	4-6	18	6	6-7	18
PHP-41	HRSA MCH NPR #15—% of women who smoke in the last 3 mos of pregnancy	6	5-7	16	5	4-6	16	6	5-7	16
*Immunizations*
PHP-8	Immunization reporting (provider registry)	5	4.5-6	16	5	3.5-7	16	5	3.5-7	16
*Well Child Care (ages birth-6 years)*
No Measures
*Adolescent Preventive Services*
PHP-11	Adolescent Well-Care Visits (NCQA)	6	5-7	19	7	6-8	19	7	6-8	19
PHP-15	Adolescent receipt of the following seven components of care during the measurement year: BMI percentile, assessment/counseling/education on nutrition, physical activity, risk behaviors associated with sexual health/activity/preventive actions, depression screening	5	5-7	17	5	3-6	17	7	6-7	17
PHP-16	Smoking Cessation and Prevention: adolescent tobacco users	5	5-7	18	5	4-5	18	6	5-8	18
*General Screening*
PHP-19	Weight Assessment and Counseling for Nutrition and Physical Activity for children and adolescents	6	5-7	13	6	5-7	13	7	7-8	13
PHP-19B	Nutrition counseling—NCQA (fix label)	6	5-7	19	5	4-7	19	7	5-7	19
PHP 19C	Physical Activity Counseling (NQCA)	6	5-7	14	5	5-7	14	6	5-7	14
PHP-29	Lead screening rate (NCQA—1st year measure—see confidential data); note USPSTF rec	6	5-7	17	6	5-7	17	6	4-7	17
PHP-29A	Lead screening 2d year—% of members who turned 2 during the reporting period and received a lead test (data from MaineCare claims and the Maine CDC)	5	4.5-6	16	5	4.5-7	16	5	4-6.5	16
PHP-29B	Lead screening 1st year—% of members who turned 1 during the reporting period and received a lead test (data from MaineCare Claims and Maine CDC)	5	4.5-6	16	5	4.5-7	16	5	4-6.5	16
PHP-29C	HRSA Lead screening in children by 2 years of age (data source differs from NCQA)	6	4-7	15	6	4-7	15	6	4-7	15
PHP-39	EPSDT—Percentage of members 0-20 years old who had one or more EPSDT procedure(s) during the reporting period	4	3-6	17	5	3-7	17	5	3-7	17
*Social/Behavioral Health Screening*
PHP-37	Percent of members under age 21 with a WCC visit by any provider during the measurement period who had a BH screen.	6	4-7	19	5	3-6	19	6	6-7	19
*Dental/Oral Health*
PHP-22A	HRSA oral health measure—the percentage of patients who had at least one dental visit during the measurement year (differs from NCQA—data source is CHCs; broader age range)	6.5	6-7	18	7	6-8	18	7	7-8	18
PHP-35	HRSA oral health measure—percentage of all dental patients with a comprehensive or periodic recall oral exam within a 12 month period	6.5	6-7	18	7	6-8	18	7	6-8	18
Management of Acute Conditions
*Acute Upper Respiratory Tract Illness*
No Measures
*Acute Otitis Externa*
AC-12	Acute Otitis Externa—Pain Assessment	6	5-7	19	5	5-6	19	5	3-5	19
*Otitis Media with Effusion*
AC-15	OME Hearing testing	6	6-7	19	6	5-7	19	6	5-7	19
*Dental*
AC-8	HRSA oral health measure—percentage of all dental patients for whom the Phase I treatment plan is completed within a 12 month period	5	4-6	18	5	3-6	18	6	5-6	18
AC-9	HRSA oral health performance measure—percentage of all dental patients with a comprehensive or periodic recall oral exam, for whom the Phase I treatment plan is documented	5	4-6	19	4	2-6	19	5	4-7	19
*Inpatient Care*
AC-7	PICU pain assessment on admission	4	3-6	19	4	3-6	19	5	3-7	19
AC-19	Care transitions—reconciled medication list received by discharged patients	6	5-7	19	4	3-5	19	7	6-8	19
AC-22	Care transitions—timely transmission of transition record (from inpatient)	6	4-7	18	5	4-6	18	6	5-7	18
*ED Care*
AC-21	Care transition—transition record with specified elements reviewed by discharged patients-ED	5	4-7	19	5	3-6	19	7	6-7	19
Management of Chronic Conditions
Mental and Behavioral Health/Substance Use
*ADHD Care*
CC-6	Diagnosis of ADHD in primary care for school age children and adolescents (using DSM)	6	5-7	18	5	4-6	18	6	5-7	18
*Depression Care*
CC-27	Child and adolescent Major Depressive Disorder (MDD)—interview of adolescent or child	6	5-7	17	5	4-6	17	6	6-8	17
CC-28	Child and adolescent Major Depressive Disorder (MDD)—diagnostic evaluation	6	5-7	18	6	4-7	18	7	5-7	18
CC-30	Child and adolescent Major Depressive Disorder (MDD)—psychotherapy	6	5-7	18	6	4-7	18	7	6-7	18
CC-32	Child and adolescent Major Depressive Disorder (MDD)—followup care	6	4-7	18	5	3-7	18	7	6-7	18
*Other Mental Health/Behavioral Care*
CC-4	Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (ages 3-17 and 18+)	6	6-7	19	6	5-7	19	7	6-7	19
CC-35	Medication adherence as measured by maximal gaps in days during a calendar year for ADHD and antipsychotic medication in children	6	5-7	17	6	4-7	17	6	4-7	17
*Children with Special Health Care Needs*
CC-37	CSHCN number of missed school days due to illness or injury	4	3-6	17	3	2-6	17	6	4-7	17
*HIV*
CC-8	Highly active antiretroviral treatment	6.5	6-8	18	5	4-6	18	6	5-8	18
*Asthma*
CC-25	Percentage of patients for whom there is documentation that a written asthma management plan was provided either to the patient or the patient's caregiver OR, at minimum, specific written instructions on under what conditions the patient's doctor should be contacted or the patient should go to the emergency room.	6	5-7	17	5	4-6	17	6	5-7	17
*Chronic Disease Identified through Newborn Screening*
CC-12	Timely followup of positive newborn screens	6	5-7	18	5	4-6	18	7	7-8	18
*Diabetes*
CC-15	Annual urine protein screening (adolescents with diabetes >16 years old)	6	5-7	19	7	6-7	19	6	6-7	19
CC-21	Hemoglobin A1c test for pediatric patients	6	3-7	13	7	4-8	13	6	4-8	15
*End-Stage Renal Disease*
No Measures
Family Experiences With Care
*HEDIS CAHPS for Children Without Chronic Conditions*
No Measures
*HEDIS CAHPS for Children with Chronic Conditions*
No Measures
*Other Family/Patient Experiences of Care Measures*
FEC-2	Helpfulness of counseling (adolescent-reported)	5	3-6	19	5	3-6	19	5	4-7	19
FEC-3	Communication and experience of care (adolescent-reported)	5	4-6	19	5	3-6	19	5	4-7	19
FEC-4	Dental CAHPS (overall ratings of dentist, dental plan, dental care, office staff)	6	4-7	19	5	4-7	19	6	5-7	19
Most Integrated Healthcare Systems
MIH-2	Medical home measure using subset of HEDIS CAHPS MEDICAID 4.0 survey items	5	4-7	16	5	4-6.5	16	7	5-8.5	16
Availability of Services
AV-1	Unduplicated members served per provider	4	2-5	18	4	2-7	18	5	2-6	18
*Uses of Services*
US-1	Utilization of ambulatory services	4.5	3-6.5	16	7	6-7.5	16	6	3-7	16
US-2	Outpatient drug utilization—per member per year average number of prescriptions	4	2-5	15	7	6-7	15	5	3-7	15
US-3	Utilization of inpatient care	4	2.5-6.5	16	7	6-8	16	6	3-6	16
Health Status
HS-2	PROMIS Pediatric item Banks: physical function, emotional distress, social role relationship, fatigue, pain and asthma	6	3-7	18	5	3-6	18	6	5-6	18
Duration of Enrollment
D-1	Prospective duration measure	6.5	5-8	18	6	5-8	18	6	5-7	18

Key:
V = Validity
F = Feasibility
I = Importance
IQR = Inter-Quartile Range
N = Number of Subcommittee members rating measure

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Current as of October 2009

Internet Citation:

Initial Core Set of Children's Healthcare Quality Measures. October 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/chip/listtable.htm