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 IV. Measure Categories

CHIPRA legislation8 requires that measures in the initial and improved core set, taken together, cover all settings, services, and topics of health care relevant to children. Moreover, the legislation requires the core set to address the needs of children across all ages,9 including services to promote healthy birth. Regardless of the eventual use of the measure, we are interested in knowing all settings, services, measure topics, and populations that this measure addresses. These categories are not exclusive of one another, so please indicate "Yes" to all that apply.

Measure CategoryDoes the measure address this category
[Yes/No drop-down]
a. Care Setting—ambulatory  
b. Care Setting—inpatient  
c. Care Setting—other—please specify [Add the following choices: home, school, other community and public health settings, long-term care, other—drop-down or radio buttons.]
d. Service—preventive health, including services to promote healthy birth  
e. Service—care for acute conditions  
f. Service—care for children with special health care needs/chronic conditions  
g. Service—other (please specify)  
h. Measure Topic—duration of enrollment  
i.  Measure Topic—clinical quality  
j.  Measure Topic—patient safety  
k. Measure Topic —family experience with care  
l.  Measure Topic—care in the most integrated setting  
m. Measure Topic—other (please specify) «Other_Topic»
n. Population—pregnant women «Age_Range»
o. Population—neonates (0-28 days after birth) (specify age range) «Age_Range»
p. Population—infants (29 days to 364 days) (specify age range) «Age_Range»
q.  Population—pre-school age children (1 year through 5 years) (specify age range) «Age_Range»
r. Population—school-age children (6 years through 10 years) (specify age range) «Age_Range»
s. Population—adolescents (11 years through 20 years) (specify age range) «Age_Range»
t. Population—other (please specify) «Age_Range»
u. Other category (please specify) «Other_Category»


8. Children's Health Insurance Program Reauthorization Act of 2009. Public Law No. 111-3, 123 Stat. 8 (2009). Available at:

9. Under Section 214 of CHIPRA, States may elect to cover the following groups under Medicaid only or under both Medicaid and CHIP: pregnant women and children up to age 19 for CHIP or up to age 21 for Medicaid.

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Current as of 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.