CHIPRA Pediatric Quality Measures Program

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Slide 1

CHIPRA Pediatric Quality Measures Program

Denise Dougherty, PhD,
Senior Advisor, Child Health and Quality Improvement
Edwin Lomotan, MD, Maushami DeSoto, PhD, MHA,
Francis Chesley, MD,
Agency for Healthcare Research and Quality (AHRQ)
U.S. Department of Health and Human Services (HHS)

Slide 2

The Basics

• The Children's Health Insurance Program Reauthorization Act (CHIPRA)—Public Law 111-3—signed by the President Feb. 2009.
• AHRQ-Centers for Medicare & Medicaid Services (CMS) Partnership:
  • Phase I: Identify initial core set of measures by January 1, 2010.
    • For voluntary use by Medicaid and CHIP programs.
    • Programs report data to CMS.
    • Secretary DHHS reports to Congress.
  • Phase II: Develop a Pediatric Quality Measures Program by January 2011.
    • Develop and enhance measures:
      • Improved core sets for voluntary use by Medicaid and CHIP—Annually beginning January 1, 2013.
      • Measures for use by public and private purchasers and programs.

Slide 3

Pediatric Quality Measures Program

• Since Early 2011.
• Components:
  • 7 Centers of Excellence in Pediatric Quality Measure Development (COEs):
    • 4 year Cooperative Agreements with AHRQ awarded in February 2011.
  • 1 CHIPRA Coordinating and Technical Assistance Center (CCTAC):
    • Contract with AHRQ awarded in April 2011.
    • Support for COEs collaborative activities; TA to AHRQ, CMS, COEs.
  • 2 Representatives from CHIPRA Quality Demonstration Grantees:
    • Illinois.
    • Massachusetts.
  • SNAC (Subcommittee on Children's Healthcare Quality Measures of the AHRQ National Advisory Council on Healthcare Research and Quality).
  • CHIPRA Federal Quality Workgroup.
  • AHRQ Staff.
  • CMS Staff.
  • Public nominators of measures.

Slide 4

The 7 COEs

Slide 5

Pediatric Quality Measures Program (PQMP) Activities: Scientific and Feasibility Workgroup

• Goal: CHIPRA requires measures that are:
  • Evidence-based.
  • Understandable.
  • Able to identify disparities.
  • Able to measure quality at the State, health plan, and provider levels of aggregation (at a minimum).
• Above a charge to SNAC; Scientific and Feasibility Workgroup fleshed out.
• Workgroup Participants: COEs, State grantees, CCTAC.
• Chair: Lawrence Kleinman, MD, CAPQUAM.
• Activities to date:
  • Identification of "desirable attributes" for assessing measures.
  • Creation of CHIPRA Candidate Measure Nomination Form (CPCF).
• Challenges:
  • Science of quality measurement relatively new.
  • Other measurement standards may not apply.
  • Assessment of measures will require judgment by SNAC.

Slide 6

PQMP Activities: Aggregation Workgroup

• Goal: CHIPRA requires that measures be reported at the following levels at a minimum:
  • State (e.g., for reporting to CMS and then Congress).
  • Health Plan.
  • Provider.
• Workgroup Participants: COEs and State Grantees.
• Co-chairs: Eric Schneider, COE4CCN; Robert Saunders, NCINQ.
• Activities to date:
  • Identify varying levels of aggregation at which measure results can be reported.
  • Construct a worksheet that measure nominators can use.
  • Produce a product.
• Challenges:
  • Many potential categories of aggregation.
  • Definitions (e.g., provider).
  • Level of detail for CPCF.

Slide 7

PQMP Activities: Race/Ethnicity/Socioeconomic Status Workgroup

• Goal: Identification and elimination of disparities required by CHIPRA.
• Participants: COEs, State grantees.
• Chair: Jeffrey Silber, CHOP.
• Activities:
  • Meaning of disparities (Paula Braveman, RTI subcontractor).
  • Matching approach (Jeff Silber).
  • RAND approach (Marc Elliott).
  • Product to come.
• Challenges:
  • Availability/variability of data.
  • Defining a disparity versus a difference.

Slide 8

PQMP Activities: Informatics Workgroup

• Goals: e-specification of measures:
  • Share knowledge on approaches.
  • Standardize across COEs if possible.
• Participants: COEs, State Grantees, CCTAC, AHRQ.
• Activities:
  • Identify which States are using EHRs for quality measurement.
  • Share strategic information across COEs.
    • Share activities of ONC contract work on CHIPRA measures.
    • Share how COEs are e-specifying measures.
    • Share other guidance.
• Challenges:
  • E-measurement is an emerging activity—learning as we go.

Slide 9

Subcommittee on Children's Healthcare Quality Measures of the AHRQ National Advisory Council on Healthcare Research and Quality (SNAC) Process 2012

Slide 10

Charge to SNAC

• Assess measures submitted by the public and COEs for potential recommendation as:
  • Improved core measures for voluntary use by Medicaid and CHIP programs.
  • Measures for use by other public and private programs.
• Use CHIPRA criteria.
• Report to the Chair, NAC.

Slide 11

SNAC Members

• Charles Gallia*.
• Charles Irwin*.
• Elizabeth (Betsy) Anderson.
• Andrea Benin.
• Gerard Carrino.
• Stephen Downs.
• Naihua Duan.
• Kim Elliott.
• Mary Evans.
• Glenn Flores.
• Paul Glassman.
• Sherrie Kaplan.
• Clint Koenig.
• Sharon-Lise Normand.
• Laura Pickler.
• Diane Rowley.
• Stephen Saunders.
• Alan Spitzer.
• Rajenu Srivastava.
• Carole Stipelman.
• Jeffery Thompson.
• Kirsten Thomsen.
• Feliciano Yu.

* Co-Chair.

Slide 12

Measure Submissions 2012

• 77 from public:
  • 27 insufficient information—returned to nominator.
  • 50 to be reviewed by SNAC.
• 13 from the COEs.
• Total reviewed: 63.

Slide 13

Measure Topics Under Review I

Cross-cutting:

• Duration of enrollment/coverage.
• Access.
• Most integrated health care setting.
• Experiences of care.
• Identification of children with special health care needs.
• Transitions/care coordination.
• Patient-reported outcomes.

Prevention Topics:

• Prenatal care.
• Immunizations.
• Development and behavior.
• Depression.
• Family psychosocial well-being.
• Substance use/abuse.
• Blood pressure.
• STIs.
• Dental.

Slide 14

Measure Topics Under Review II

Acute care management:

• Gastroenteritis.
• Patient safety—various.
• Imaging.

Chronic care management:

• Asthma.
• ADHD.
• Mental health care.
• Tobacco use.
• Cardiac conditions.

Slide 15

For more information

• http://www.ahrq.gov/CHIPRA.
• Denise.dougherty@ahrq.hhs.gov.