Modifying pediatric quality care measures may capture more care services
Applying clinically relevant changes to national pediatric quality measures, and gathering data from electronic medical records (EMRs), finds more services provided to children than do strict national quality guidelines drawing on claims-based data, according to a new study. The need to modify the quality measures was motivated, in part, by the differences between claims-based data and EMR data (for example, claims-based data do not include information on patients who are uninsured), the researchers note. They identified pediatric quality measures that had been developed to meet the mandate of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and were of interest to providers at the safety-net clinic they were studying. The measures include at least six well-child visits (WCVs) for children by 15 months; receipt of 10 recommended early childhood immunizations by age 2; receipt of a specified new and booster adolescent immunization between ages 10 and 13; and recording (between ages 3 and 15) of the patient’s body mass index (BMI) percentile within a year of the measurements.
For WCVs, 52 percent of children under 3 years old attended at least six WCVs by 15 months, and 61 percent had the required number by age 2. Also, 8 of the 10 early childhood vaccine series had been received by 65 percent of the children by age 2, a percentage rising to 70 percent by age 3. Using EMR data, the researchers were able to identify, and drop from the denominator, instances of parental refusal of a vaccine—noted as 15 percent of children whose parents refused at least 1 of 21 vaccine administrations. The CHIPRA mandate that adolescents receive a Tdap or TD booster plus a meningococcal vaccination by age 13 was met by 43 percent of the relevant age group (69 percent for Tdap or TD; 46 percent for meningococcal vaccine). When the age limit was extended to 15 years, the compliance rates were 83 percent and 57 percent, respectively. For BMI documentation, recording the percentile within a year of the measurements occurred with 63 percent, which rose to 91 percent with a 36-month window. Data were collected retrospectively from a single clinic for all children ages 6 months to 15 years as of July 1, 2011. The researchers conclude that strict adherence to measure definitions might miss the true quality of care provided, especially among populations that may have sporadic patterns of care use. Their study was funded in part by the Agency for Healthcare Research and Quality (HS18569).
More details are in "Are pediatric quality measures too stringent?" by Allison Casciato, B.A., Heather Angier, M.P.H., Christina Milano, M.D., and others in the September–October 2012 Journal of the American Board of Family Medicine 25(5), pp. 686-693.