Lessons from the Field Reports
The Pediatric Quality Measures Program (PQMP) was established to increase the portfolio of evidence-based, consensus pediatric quality measures available to public and private purchasers of children's health care services. It was established following enactment of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). At that time, the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) began working together to implement selected provisions of the legislation related to advancing healthcare quality and health equity among low-income children.
The initial phase of the PQMP focused on developing new and enhanced pediatric measures. In the second phase ("PQMP 2.0"), AHRQ awarded grants to six multistakeholder partnership teams to implement and disseminate selected measures. The grantees planned projects aimed at addressing six research questions, called research foci, that put forward issues concerning PQMP measure implementation and dissemination, as well as factors affecting real-world usability and feasibility. Organized by domain, these research foci are shown in the following table.
|Using quality measures at multiple levels||How can the same measure be used to evaluate quality of care between multiple levels (i.e., state, health plan, and provider levels) to ascertain how improvement at one level drives overall improvement at the state level?|
|What are the appropriate uses for each measure and each level of measurement, given a measure's "intended use" by the developer/steward? What are the different standards and criteria that should be applied to the development and use of measures for payment versus quality improvement? How do we determine measures can be appropriately used/aggregated at multiple levels (state, health plan, and provider levels) and be "folded up or down"?|
|Making performance comparisons||How might relative performance be compared at each level, such as between different provider groups/organizations (e.g., Federally Qualified Health Centers, pediatric group practice, multi-specialty group practice) or between different Accountable Care Organizations/managed care health plans?|
|What are evidence-based and scientifically sound methods for benchmarking progress on these measures? What level of improvement can be expected for measures—and in what time frame—taking into account different quality improvement approach(es) undertaken at different levels? For example, if improvement is likely to be more rapid at the provider-level, what are the implications for performance targets established at the state level?|
|Identifying measurement challenges/successes||What measurement (e.g., data collection, reporting, quality improvement) challenges and successes are identified at different levels (e.g., state, health plan, practice, provider, patient levels)?|
|Assessing intermediate progress||For those measures for which improvement is unlikely to be seen within the CMS annual reporting cycle (calendar year), how might "intermediate" progress be measured at other levels that would predict improvement at the state level, with a high predictive value?|
The grantees also participated in a Learning Collaborative, which set out to augment their findings through additional research activities. The PQMP Learning Collaborative conducted literature reviews, interviewed key informants, and synthesized findings from the grantee demonstration projects to create a more indepth analysis and review of the research foci. Published literature proved to be somewhat limited, increasing the value of the lessons conveyed through the key informant interviews and the grantees' real-world quality improvement activities, empirical analyses, and involvement in implementation efforts.
These grantee lessons are described in the following Lessons from the Field reports. The reports are organized by the research foci domains––using quality measures at multiple levels, making performance comparisons, identifying measurement challenges and successes, and assessing intermediate progress. Each report offers a synthesis of the lessons learned and findings from the literature, key informants, and grantees' implementation and dissemination experiences.
- Lessons from the Field: Using Pediatric Quality Measures across Multiple Levels (PDF, 509 KB).
- Lessons from the Field: Making Performance Comparisons (PDF, 351 KB).
- Lessons from the Field: Identifying Measurement Challenges and Successes (PDF, 399 KB).
- Lessons from the Field: Measuring Intermediate Progress (PDF, 517 KB).