Child Health Care Quality Toolbox
The increasing demand for and use of quality measurement information generates interest in developing new measures in areas for which none exists, as well as refining and updating measures already in use. Organized and funded quality measure development activities are ongoing. This section focuses on selected measures that are undergoing extensive development.
Updating and refinement of measures in established quality measurement sets such as the Consumer Assessment of Health Plans (CAHPS®), AHRQ Quality Indicators (AHRQ QIs), Health Plan Employer Data and Information Set (HEDIS®), and Title V Maternal and Child Health Programs are ongoing.
For more information on CAHPS®, go to: http://www.ahrq.gov/chtoolbx/measure2.htm
For more information on AHRQ QIs, go to: http://www.ahrq.gov/chtoolbx/measure3.htm
For more information on HEDIS®, go to: http://www.ahrq.gov/chtoolbx/measure4.htm
For more information on Title V Maternal and Child Health Programs, go to: http://www.ahrq.gov/chtoolbx/measure5.htm
Child and Adolescent Health Measurement Initiative
The Child and Adolescent Health Measurement Initiative (CAHMI) has three multi-item survey measures that have undergone extensive development activities and will be available in 2004. They are:
- Ambulatory Care Sensitive Hospitalization Measurement Project
- Medical Home for Children with Special Health Care Needs (CSHCN)
- Mental and Behavioral Quality Measures for Children and Adolescents
The Data Resource Center for Child and Adolescent Health allows users to search and display charts and tabular findings from individual survey items as well as derived key child health measures from these data sources.
To access the Data Resource Center (DRC) for Child and Adolescent Health, go to: http://www.childhealthdata.org
Ambulatory Care Sensitive Hospitalization Measurement Project
The purpose of this project is to develop and test a standardized set of measures to assess the effectiveness of Medicaid managed care organizations, primary care case management programs, and ambulatory fee-for-service programs in delivering appropriate and timely care for conditions common in childhood.
Information for these measures will be obtained through administrative claims data on hospitalizations for each of the following age groups: 0-1, 2-4, 5-9, and 10-14 years. Some hospitalizations are considered avoidable with timely and appropriate primary care services. CAHMI is working with States and experts to specify and test alternative approaches to constructing measures useful for State policymakers.
Specifications and tool kits for using the measurements will be made available through the CAHMI Web site. Further information is available through CAHMI staff at firstname.lastname@example.org.
For more information on CAHMI, go to: http://www.ahrq.gov/chtoolbx/measures.htm
For the CAHMI Web site, go to: http://www.cahmi.org
Medical Home for Children with Special Health Care Needs (CSHCN)
The purpose of this project is to develop, test, and gain consensus on a uniform strategy for measuring medical home for Children with Special Health Care Needs at both State and Federal levels. The project uses existing national surveys, such as:
- The National Survey of Children's Health, sponsored by the Maternal and Child Health Bureau.
- The Medical Expenditure Panel Survey (MEPS).
Under the Title V Maternal and Child Health Programs, each State is required to report on CSHCN who have access to a medical home. The criteria established by each State vary widely since no standard definition exists. By using existing data, as well as by drawing on the knowledge and experience of consumers and professionals in the field, this project will establish a standardized way to measure medical home access.
An expert advisory group has been working to guide the development of a measure and technical specifications, and to work with survey sponsors to identify gaps in available data to construct an "ideal" measure. Models for measuring medical home using the CAHPS® survey will be available on the CAHMI Web site in 2004. Models for measuring medical home using data from the National Survey of Children with Special Health Care Needs, a national survey conducted by the Centers for Disease Control and Prevention, will be available late in 2004 on the CAHMI Web site.
For the National Survey of Children with Special Health Care Needs, go to: http://www.cdc.gov/nchs/slaits.htm#Contact%20SLAITS
For the CAHMI Web site, go to: http://www.cahmi.org
Mental and Behavioral Health Quality Measures for Children and Adolescents
This project assesses the potential of using the CAHPS® data to yield potential measures for monitoring the quality of behavioral and mental health care to children and adolescents.
This project was developed under CAHMI with support from the Centers for Medicare & Medicaid Services. It focuses on identifying methods and strategies for using available data to evaluate the quality of mental and behavioral health services to children and adolescents enrolled in Medicaid. Given the significant percentage of Medicaid funds spent on mental health services for children and adolescents, State and Federal policymakers are looking for ways to assess the quality of these services. The measures identified in this project are expected to have application in non-Medicaid populations as well.
Tools developed from this work will use existing data to determine whether mental or behavioral health services have been used. Thus, these measures will be targeted to the general population of children who may not be identifiable in the mental or behavioral health service system.
The project has two phases. In Phase I, an expert advisory group was established to assess the potential of using CAHPS® data to yield potential measures for assessing the quality of behavioral and mental health care to children and adolescents. Existing gaps in current measurement also were identified.
Phase II involves a six-stage development process:
- Develop a scientific paper on a conceptual framework for development of measures.
- Conduct a focused literature review.
- Conduct consumer focus groups to identify which areas of quality consumers perceive to be of greatest relevance.
- Establish and obtain input from an expanded advisory group.
- Develop a measurement proposal.
- Select options for further development and design a protocol for field testing.
Models for analyzing CAHPS® data to measure mental and behavioral health for children and adolescents will be available on the CAHMI Web site in 2004.
Online Resource: For the CAHMI Web site, go to: http://www.cahmi.org
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has long been the designated accreditation agency for hospitals and other health care facilities. In 1997, JCAHO added quality measurement requirements to existing requirements for participation in the accreditation process for hospitals and long-term care facilities in an initiative called ORYX™.
The ORYX™ initiative requires hospitals and long-term care organizations to:
- Identify and begin to use existing quality measurement systems.
- Produce quality measurement results as a part of the JCAHO accreditation process.
JCAHO-accredited providers of other types of health care, such as home care and hospice, behavioral health care, and pathology and clinical laboratory services, will be required to participate in ORYX™ as the initiative is fully implemented.
In 2001, JCAHO announced four Core Measure Set Areas for introduction into the JCAHO hospital accreditation program. They are:
- Acute myocardial infarction (including coronary artery disease).
- Heart failure.
- Pneumonia (community acquired).
- Pregnancy and related conditions (including newborn mortality).
Children's asthma care is under consideration as a candidate core measure set. Through a collaborative effort initiated by JCAHO with five national Children's health organizations—Child Health Corporation of America, Medical Management Plan, National Association of Children's Hospitals and Related Institutions, National Initiative of Children's Healthcare Quality, and the Nemours Foundation—the following asthma care measures were identified:
- Asthma unplanned readmission within 7 days following discharge.
- Asthma unplanned readmission within 30 days following discharge.
- Return to the emergency department within 48 hours following inpatient stay for asthma.
- Use of systemic corticosteroids for inpatient asthma by age group.
- Use of relievers for inpatient asthma by age group.
- Risk-adjusted average length of stay for asthma patients.
These asthma care measures have received public comment and may undergo further testing and refinement. More information about ORYX™ core measures and candidate measures are available through the JCAHO Web site.
The ORYX™ measurement initiative deals with accreditation of health care organizations and is not designed for use by health care purchasers or regulators. However, as the ORYX™ initiative progresses, States might find it useful to learn the ORYX™ status of the health care organizations that are providing care to people enrolled in child health and other publicly funded health care programs.
For the JCAHO Web site, go to: http://www.jcaho.org/
For more information on ORYX™, go to: https://www.jointcommission.org/measurement/reporting/accreditation-oryx/