Background Report on 2013 Retirement of Measures from the Child Core Set

Appendix C. Definitions for Prevalence/Incidence and Cost/Utilization per Measure

Prevalence/Incidence (Source) Health Care Cost/Utilization (Source)
1. Timeliness of Prenatal Care 
  • Number of discharges for liveborns with Medicaid as payer (HCUPNet, 2011)
  • Number of discharges for liveborns with Medicaid as payer by race/ethnicity (MAX)
  • Number of discharges for liveborns for all payers (HCUPNet, 2011)
  • Medicaid percentage of all payer discharges for liveborns (HCUPNet, 2011)
  • Aggregate costs and mean costs per discharge for liveborns with Medicaid as payer (HCUPNet, 2011)
  • Aggregate costs and mean costs per discharge for liveborns with Medicaid as payer by race/ethnicity (MAX)
  • Aggregate costs and mean cost per discharge for liveborns all payers (HCUPNet, 2011)
  • Medicaid percentage of all payer costs for liveborns (HCUPNet, 2011)
2. Frequency of Ongoing Prenatal Care 
  • Number of discharges for liveborns with Medicaid as payer (HCUPNet, 2011)
  • Number of discharges for liveborns with Medicaid as payer by race/ethnicity (MAX)
  • Number of discharges for liveborns for all payers (HCUPNet, 2011)
  • Medicaid percentage of all payer discharges for liveborns (HCUPNet, 2011)
  • Aggregate costs and mean costs per discharge for liveborns with Medicaid as payer (HCUPNet, 2011)
  • Aggregate costs and mean costs per discharge for liveborns with Medicaid as payer by race/ethnicity (MAX)
  • Aggregate costs and mean cost per discharge for liveborns all payers (HCUPNet, 2011)
  • Medicaid percentage of all payer costs for liveborns (HCUPNet, 2011)
3. Live Births Weighing Less Than 2,500 Grams 
  • Number of discharges for premature birth and low birth weight with Medicaid as payer (HCUPNet, 2011)
  • Number of discharges for premature birth and low birth weight with Medicaid as payer by race/ethnicity (MAX)
  • Number of discharges for premature birth and low birth weight for all payers (HCUPNet, 2011)
  • Medicaid % of all payer discharges for premature birth and low birth weight (HCUPNet, 2011)
  • Aggregate costs and mean costs per discharge for hospitalizations for premature birth and low birth weight with Medicaid as payer (HCUPNet, 2011)
  • Aggregate costs and mean costs per discharge for hospitalizations for premature birth and low birth weight with Medicaid as payer by race/ethnicity (MAX)
  • Aggregate costs and mean cost per discharge for premature birth and low birthweight all payers (HCUPNet, 2011)
  • Medicaid percentage of all payer costs for premature birth and low birth weight (HCUPNet, 2011)
4. Cesarean Rate for Nulliparous Singleton Vertex 
  • Number of discharges for cesarean deliveries with Medicaid as payer (HCUPNet, 2011)
  • Number of discharges for cesarean deliveries with Medicaid as payer by race/ethnicity (MAX)
  • Number of discharges for cesarean deliveries all payers (HCUPNet, 2011)
  • Medicaid percentage of all payer discharges for cesarean deliveries (HCUPNet, 2011)
  • Aggregate costs and mean costs per discharge for hospitalizations for cesarean deliveries with Medicaid as payer (HCUPNet, 2011)
  • Aggregate costs and mean costs per discharge for hospitalizations for cesarean deliveries with Medicaid as payer by race/ethnicity (MAX)
  • Aggregate costs and mean cost per discharge for cesarean deliveries all payers (HCUPNet, 2011)
  • Medicaid % of all payer costs for cesarean deliveries (HCUPNet, 2011)
5. Childhood Immunization Status 
  • Number of  Medicaid/CHIP-enrollees who turn 2 during the year (MAX)
  • Number of  Medicaid/CHIP-enrollees who turn 2 during the year by race/ethnicity (MAX)
  • Existing literature
6. Adolescent Immunization Status 
  • Number of  Medicaid/CHIP-enrollees who turn 13 during the year (MAX)
  • Number of  Medicaid/CHIP-enrollees who turn 13 during the year by race/ethnicity (MAX)
  • Existing literature
7. Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents: Body Mass Index Assessment for  Children/Adolescents 
  • Number and percentage of children age 10-17 with public insurance who are obese (NSCH)
  • Number of Medicaid/CHIP enrollees age 3-17 (MAX)
  • Number of Medicaid/CHIP enrollees age 3-17 by race/ethnicity (MAX)
  • Number and  percentage of children age 10-17 who are obese (NSCH)
  • Number and  percentage of children age 10-17 who are obese by race/ethnicity (NSCH)
  • Number and  percentage of children age 10-17 who are obese by income level (NSCH) 
  • Number and  percentage of children age 10-17 who are obese by special health care needs status (NSCH)
  • Medicaid as percentage of the total population (NSCH)
  • Existing literature
8. Developmental Screening In the First Three Years of Life 
  • Number and percentage of children age 2-17 with public insurance who have developmental delay (NSCH)
  • Number of Medicaid/CHIP enrollees ages 0-3 (MAX)
  • Number and percentage of children age 2-17 with developmental delay (NSCH) 
  • Number and percentage of children age 2-17 with developmental delay by race/ethnicity (NSCH)
  • Number and percentage of children age 2-17 with developmental delay by income level (NSCH)
  • Number and percentage of children age 2-17 with developmental delay by special health care needs status (NSCH) 
  • Medicaid as % of total population (NSCH)
  • Existing Literature
  • Existing literature
9. Chlamydia Screening—sexually active females ages 16-20 
  • Number of female Medicaid/CHIP enrollees age 16-20 who are sexually active (MAX)
  • Existing Literature 
  • Total Medicaid expenditures for claims with diagnosis code for pelvic inflammatory disease for females age 16-20 (MAX)
  • Total Medicaid expenditures for claims with diagnosis code for pelvic inflammatory disease for females age 16-20 by race/ethnicity (NSCH)
10. Well-Child Visits in the First 15 Months of Life 
  • Number of Medicaid/CHIP enrollees age 0—15 months (MAX)
  • Number of Medicaid/CHIP enrollees age 0—15 months by race/ethnicity (MAX)
  • Number of well-child visits for children age 0-15 months (MAX) 
  • Number of well-child visits for children age 0-15 months by race/ethnicity (MAX)
  • Total Medicaid expenditures for well-child visits for children age 0-15 months (MAX)
  • Total Medicaid expenditures for well-child visits for children age 0-15 month by race/ethnicity (MAX)
11. Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life 
  • Number of  Medicaid/CHIP enrollees age 3—6 years (MAX)
  • Number of  Medicaid/CHIP enrollees age 3—6 years by race/ethnicity (MAX)
  • Number of well-child visits for children age 3-6 (MAX)
  • Number of well-child visits for children age 3-6 by race/ethnicity (MAX)
  • Total Medicaid expenditures for well-child visits for children age 3—6  (MAX)
  • Total Medicaid expenditures for well-child visits for children age 3—6 by race/ethnicity (MAX)
12. Adolescent Well-Care Visit 
  • Number of Medicaid/CHIP-enrollees age 12-17 years (MAX)
  • Number of Medicaid/CHIP-enrollees age 12-17 years by race/ethnicity (MAX)
  • Number of well-child visits for children age 12-17 (MAX)
  • Number of well-child visits for children age 12-17 by race/ethnicity (MAX)
  • Total Medicaid expenditures for well-child visits for children age 12-17 (MAX)
  • Total Medicaid expenditures for well-child visits for children age 12-17 by race/ethnicity (MAX)
13. Child and Adolescent Access to Primary Care Practitioners 
  • Number of  Medicaid/CHIP-enrollees (MAX)
  • Number of  Medicaid/CHIP-enrollees by age (12-24 months, 25 months6 years, 7-11 years, 12-19 years) (MAX)
  • Number of  Medicaid/CHIP-enrollees by race/ethnicity (MAX)
14. Appropriate Testing for Children with Pharyngitis 
  • Percentage of children enrolled in Medicaid  who sought treatment for sore throat (not pharyngitis specific), 2002-2004 (MEPS)
  • Percentage of total children who sought treatment for sore throat (not pharyngitis specific) (MEPS)
  • Percentage of total children who sought treatment for sore throat (not pharyngitis specific) by race/ethnicity (MEPS)
  • Medicaid expenditures for antibiotic prescriptions to treat pharyngitis for children age 2-18 (MAX)
  • Medicaid expenditures for antibiotic prescriptions to treat pharyngitis for children age 2-18 by race/ethnicity (MAX)
  • Medicaid expenditures for antibiotic prescriptions to treat pharyngitis for children age 2-18 as a percentage of total Medicaid expenditures for prescriptions for children age 2-18 (MAX)
  • Medicaid expenditures for antibiotic prescriptions to treat pharyngitis for children age 2-18 as a percentage of total Medicaid expenditures for prescriptions for children age 2-18 by race/ethnicity (MAX)
15. Ambulatory Care—Emergency Department (ED) Visits 
  • Number of Medicaid/CHIP enrollees age 0-19 with ED visits (MAX)
  • Number of Medicaid/CHIP enrollees age 0-19 with ED visits by age (<1, 1-9, 10-19) (MAX)
  • Number of Medicaid/CHIP enrollees age 0-19 with ED visits by race/ethnicity (MAX)
  • Number of ED visits among children age 0-19 (MAX)
  • Number of ED visits among children by age 0-19 age (<1, 1-9, 10-19) (MAX)
  • Number of ED visits among children age 0-19 by race/ethnicity (MAX)
  • Total expenditures for ED visits for children age 0-19 (MAX)
  • Total expenditures for ED visits for children age 0-19 by age (<1, 1-9, 1019) (MAX)
  • Total expenditures for ED visits for children age 0-19 by race/ethnicity (MAX)
  • Mean expenditures per ED visit (MAX)
  • Mean expenditures per ED visit by age (<1, 1-9, 10-19) (MAX)
  • Mean expenditures per ED visit by race/ethnicity (MAX)
  • Mean expenditures for ED visits per child (MAX)
  • Mean expenditures for ED visits per child by age (<1, 1-9, 10-19) (MAX)
  • Mean expenditures for ED visits per child by race/ethnicity (MAX)
16. Pediatric Central Line–Associated Blood Stream Infections—Neonatal Intensive Care Unit and Pediatric Intensive Care Unit 
  • Number of admissions with NICU or PICU hospital stays (MAX)
  • Number of admissions with NICU or PICU hospital stays by race/ethnicity (MAX)
  • Admissions with NICU or PICU stay as percentage of total hospital admissions for children (MAX)
  • Admissions with NICU or PICU stay as percentage of total hospital admissions for children by race/ethnicity (MAX)
  • Total and mean Medicaid expenditures per discharge for admissions that include NICU or PICU stays (MAX)
  • Total and mean Medicaid expenditures per discharge for admissions that include NICU or PICU stays by race/ethnicity (MAX)
17. Annual Percentage of Asthma Patients 2 Through 20 Years Old with One or More Asthma-Related Emergency Room Visits 
  • Number and percentage of children age 0-17 with public insurance who have current asthma (NSCH)
  • Number and percentage of total children age 2-17 with current asthma (NSCH)
  • Number and percentage of total children age 2-17 with current asthma by race/ethnicity (NSCH)
  • Number and percentage of total children age 2-17 with current asthma by income level (NSCH)
  • Number and percentage of total children age 2-17 with current asthma by special health care needs status (NSCH)
  • Medicaid as a percentage of the total population (NSCH)
  • Number of child ED visits for asthma among children age 2-20 (MAX)
  • Number of child ED visits for asthma among children age 2-20 by race ethnicity (MAX)
  • Mean child Medicaid expenditures per ED visit for asthma among children age 2-20 (MAX)
  • Mean child Medicaid expenditures per ED visit for asthma among children age 2-20 by race/ethnicity (MAX)
  • Total Medicaid expenditures for ED visits with asthma diagnosis among children age 2-20 (MAX)
  • Total Medicaid expenditures for ED visits with asthma diagnosis among children age 2-20 by race/ethnicity (MAX)
  • Medicaid expenditures for ED visits for asthma for children age 2-20 as a percentage of total Medicaid expenditures for ED visits for children age 2-20 (MAX)
  • Asthma-related ED visits for children age 2-20 as a percentage of total ED visits for children age 2-20 (MAX)
18. Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder (ADHD) Medication 
  • Number and percentage of children age 2-17 with public insurance with ADD or ADHD (NSCH)
  • Number and percentage of children age 2-17 with public insurance with ADD/ADHD currently taking medication for this condition (NSCH)
  • Number and percentage of children age 2-17 with ADD or ADHD (NSCH)
  • Number and percentage of children age 2-17 with ADD or ADHD by race/ethnicity (NSCH)
  • Number and percentage of children age 2-17 with ADD or ADHD by income level (NSCH)
  • Number and percentage of children age 2-17 with ADD or ADHD by special health care needs status (NSCH)
  • Medicaid as  a percentage of total population (NSCH)
  • Number and percentage of children age 2-17 with ADD/ADHD currently taking medication for this condition (NSCH)
  • Number and percentage of children age 2-17 with ADD/ADHD currently taking medication for this condition by race/ethnicity (NSCH)
  • Number and percentage of children age 2-17 with ADD/ADHD currently taking medication for this condition by income level (NSCH)
  • Number and percentage of children age 2-17 with ADD/ADHD currently taking medication for this condition by special health care needs status (NSCH)
  • Medicaid as % of total population (NSCH)
  • Total expenditures for prescriptions for ADHD medications among children age 6-12 (MAX) 
  • Total expenditures for prescriptions for ADHD medications among children age 6-12 by race/ethnicity (MAX)
  • Expenditures for prescriptions for ADHD as percentage of total Medicaid expenditures for children age 6-12 (MAX)
  • Expenditures for prescriptions for ADHD as percentage of total Medicaid expenditures for children age 6-12 by race/ethnicity (MAX)
  • Expenditures for prescriptions for ADHD as percentage of Medicaid expenditures for prescriptions for children as 6-12 (MAX)
  • Expenditures for prescriptions for ADHD as percentage of Medicaid expenditures for prescriptions for children as 6-12 by race/ethnicity (MAX)
  • Expenditures for prescriptions for ADHD as percentage of total Medicaid expenditures for prescriptions (total population <65) (MAX)
  • Expenditures for prescriptions for ADHD as percentage of total Medicaid expenditures for prescriptions (total population <65) by race ethnicity (MAX)
  • Medicaid as percentage of total (all-payer) expenditures for treatment of ADHD (MEPS)
  • Medicaid as percentage of total (all-payer) ambulatory ADHD visit expenditures (MEPS)
  • Medicaid as % of total (all-payer) expenditures for prescription medications for ADHD (MEPS)
19. Annual Pediatric Hemoglobin A1C Testing 
  • Number and percentage of  children in public insurance age 0-17 with current diabetes (NSCH)
  • Number and percentage of children age 0-17 with current diabetes (NSCH)
  • Number and percentage of children age 0-17 with current diabetes by race/ethnicity (NSCH)
  • Number and percentage of children age 0-17 with current diabetes by income level (NSCH)
  • Number and percentage of children age 0-17 with current diabetes by special health care needs status (NSCH)
  • Medicaid as % of total population (NSCH)
  • Number of hospital admissions and ED visits with diagnosis code for diabetes among children ages 0-17 (MAX)
  • Number of hospital admissions and ED visits with diagnosis code for diabetes among children ages 0-17 by race/ethnicity (MAX)
  • Mean Medicaid expenditures per hospital admission/ED visit (MAX)
  • Mean Medicaid expenditures per hospital admission/ED visit by race/ethnicity (MAX)
  • Total Medicaid expenditures for hospital admissions and ED visits  (MAX)
  • Total Medicaid expenditures for hospital admissions and ED visits by race/ethnicity (MAX)
  • Number of aggregate costs and mean cost per discharge for hospitalizations for diabetes with complications, and separately for diabetes without complications with Medicaid as payer (HCUPNet, 2011)
  • Number of ED visits with first-listed diagnosis code of diabetes with complications, and separately for first-listed diagnosis diabetes without complications for people enrolled in Medicaid, all ages.  (HCUPNet, 2010)
  • Hospital admissions/ED visits with diagnosis code for diabetes as percentage  of total Medicaid expenditures for hospital admissions and ED visits for children age 0-17 (MAX)
  • Medicaid costs for discharges for diabetes as % of total Medicaid costs for hospital discharges for children (HCUPNet, 2011)
  • Aggregate costs and mean cost per discharge for diabetes with complications, and separately for diabetes mellitus without complications all payers (HCUPNet, 2011)
  • Medicaid as percentage of total (all-payer) discharges and aggregate costs for diabetes with complications, and separately for diabetes without complications (HCUPNet, 2011)
  • Number of ED visits with first-listed diagnosis code of diabetes mellitus with complications, and separately for first-listed diagnosis code of diabetes mellitus without complications for children age 1-17, all payer (HCUPNet, 2010)
20. Follow-Up After Hospitalization for Mental Illness  ages 6+ 
  • Number of Medicaid/CHIP enrollees age 6-20 with a hospital or other inpatient or residential admission for a mental health disorder (MAX)
  • Number of Medicaid/CHIP enrollees age 6-20 with a hospital or other inpatient or residential admission for a mental health disorder by race/ethnicity (MAX)
  • Existing Literature
  • Children age 6-20 with an admission for a mental health disorder as % of all Medicaid/CHIP enrollees age 6-20 (MAX)
  • Children age 6-20 with an admission for a mental health disorder as % of all Medicaid/CHIP enrollees age 6-20 by race/ethnicity (MAX)
  • Number of admissions for children age 6-20 for hospital admissions with a diagnosis code for a mental health disorder  (MAX)
  • Number of admissions for children age 6-20 for hospital admissions with a diagnosis code for a mental health disorder by race/ethnicity (MAX)
  • Mean Medicaid expenditures per admission for children age 6-20 for hospital admissions with a diagnosis code for a mental health disorder (MAX)
  • Mean Medicaid expenditures per admission for children age 6-20 for hospital admissions with a diagnosis code for a mental health disorder by race/ethnicity (MAX)
  • Total Medicaid expenditures for children age 6-20 for hospital admissions with a diagnosis code for a mental health disorder (MAX)
  • Total Medicaid expenditures for children age 6-20 for hospital admissions with a diagnosis code for a mental health disorder by race/ethnicity (MAX)
  • Medicaid expenditures for children age 6-20 for hospital admissions with a diagnosis code for a mental health disorder as % of total Medicaid expenditures for children age 6-20 (MAX)
  • Medicaid expenditures for children age 6-20 for hospital admissions with a diagnosis code for a mental health disorder as % of total Medicaid expenditures for children age 6-20 by race/ethnicity (MAX)

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Current as of February 2014
Internet Citation: Background Report on 2013 Retirement of Measures from the Child Core Set: Appendix C. Definitions for Prevalence/Incidence and Cost/Utilization per Measure. February 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/chipra/measure_retirement/measure_retirementapc.html