Candidate Measure Submission Form (CPCF)

CHIPRA Pediatric Quality Measures Program (PQMP)

The CHIPRA Pediatric Quality Measures Program (PQMP) Candidate Measure Submission Form (CPCF) was approved by the Office of Management and Budget (OMB) in accordance with the Paperwork Reduction Act.  The OMB Control Number is 0935-0205 and the Expiration Date is December 31, 2015.

Section III. Importance of the Measure

In the following sections, provide brief descriptions of how the measure meets one or more of the following criteria for measure importance (general importance, importance to Medicaid and/or CHIP, complements or enhances an existing measure). Include references related to specific points made in your narrative (not a free-form listing of citations).

III.A. Evidence for General Importance of the Measure

Provide evidence for all applicable aspects of general importance, including but not limited to the following:

  • Addresses a known or suspected quality gap or disparity in quality (e.g., addresses a socioeconomic disparity, a racial/ethnic disparity, a disparity for Children with Special Health Care Needs (CSHCN) and/or a disparity for limited English proficiency (LEP) populations. 
  • Potential for quality improvement (i.e., there are effective approaches to reducing the quality gap or disparity in quality).
  • Prevalence of condition among children under age 21 and/or among pregnant women.
  • Severity of condition and burden of condition on children, family, and society (unrelated to cost).
  • Fiscal burden of measure focus (e.g., clinical condition) on patients, families, public and private payers, or society more generally, currently and over the life span of the child.
  • Association of measure topic with children’s future health—for example, a measure addressing childhood obesity may have implications for the subsequent development of cardiovascular diseases.
  • The extent to which the measure is applicable to changes across developmental stages (e.g., infancy, early childhood, middle childhood, adolescence, young adulthood).

«Evidence_of_General_Importance» Character limit: 7500

+ Opportunity to upload attachment.

III.B. Evidence for Importance of the Measure to Medicaid and/or CHIP

Comment on any specific features of this measure important to Medicaid and/or CHIP that are in addition to the evidence of importance described above, including the following:

  • The extent to which the measure is understood to be sensitive to changes in Medicaid or CHIP (e.g., policy changes, quality improvement strategies).
  • Relevance to the Early and Periodic Screening, Diagnostic and Treatment benefit in Medicaid (EPSDT).7
  • Any other specific relevance to Medicaid/CHIP (please specify).

«Evidence_of_Importance_to_Medicaid_CHIP» Character limit: 7500

+ Opportunity to upload attachment.

III.C. Relationship to Other Measures (if any)

Describe, if known, how this measure complements or improves on an existing measure in this topic area for the child or adult population, or if it is intended to fill a specific gap in an existing measure category or topic. For example, the proposed measure may enhance an existing measure in the initial core set, it may lower the age range for an existing adult-focused measure, or it may fill a gap in measurement (e.g., for asthma care quality, inpatient care measures).

«Other_Measures» Character limit: 7500

+ Opportunity to upload attachment.


7. The EPSDT is a comprehensive set of benefits available to children and youth under age 21 who are enrolled in Medicaid.  For more information, go to http://www.healthlaw.org/images/stories/epsdt/3-ESDPT08.pdf.


Return to Contents
Proceed to Next Section

Page last reviewed December 2013
Internet Citation: Candidate Measure Submission Form (CPCF): CHIPRA Pediatric Quality Measures Program (PQMP). December 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/chipra/cpcf-form3.html