States have a particular interest in quality measurement and improvement. They insure their most vulnerable children through Medicaid/CHIP and are responsible for promoting effective and efficient care for them. States are interested in developing efficient systems for quality reporting with the goal of stimulating improvements in care for their residents. However, it has been challenging to find pediatric measures that allow for fair comparisons across institutions, account for differences in patient populations (e.g., prevalence of chronic conditions), and provide information that is understandable and useful to families and providers.
As part of the AHRQ Pediatric Quality Measures Program (PQMP), the Center of Excellence for Pediatric Quality Measurement (CEPQM) at Boston Children’s Hospital worked with state programs to ensure that states could meaningfully use the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) Survey to compare within and across state-level hospitals. Due to the lack of publicly available Child HCAHPS datasets during the time period of the AHRQ grant, the analysis was simulated in two ways.
State-Level Simulation #1
CEPQM worked with two states to test Child HCAHPS for validity, feasibility, and usability. The results were intended for state users to inform further development of strategies to streamline data collection and measure reporting.
To simulate the calculation of hospital case-mix adjusted Child HCAHPS scores at the state level, the states were provided with a deidentified raw dataset of survey results from a subset of hospitals that participated in the Child HCAHPS National Field Test. With permission from the hospitals, data was securely transferred from seven hospitals to each of the CEPQM team’s state partners. Using Child HCAHPS technical specifications, the states analyzed and calculated case-mix adjusted hospital-level and state-level scores.
Both states were able to successfully analyze hospital and state performance utilizing the dataset provided.
State-Level Simulation #2
State-level comparisons of Child HCAHPS measures is also important as Medicaid/CHIP currently follow state-level performance.
Given the lack of a national database, the CEPQM team wanted to simulate state-level comparisons using the Child HCAHPS National Field Test data. The data included 69 hospitals in 32 states. To provide sufficient hospitals within each “state,” the CEPQM team analyzed the hospital-level adjusted mean scores by U.S. Census Bureau regions (Northeast, Midwest, South, and West) and divisions (New England, Middle Atlantic, East North Central, West North Central, South Atlantic, East South Central, West South Central, Mountain, and Pacific). Using Child HCAHPS SAS program, included in this toolkit in the Other Resources section, the team was able to analyze regional performance for the 18 single-item and composite measures that comprise Child HCAHPS across the geographic regions.
Significant variation was noted for most of the items. Results of the regions, divisions, and variation across both are found in an Excel file (28 KB) which can be downloaded from the AHRQ site. These findings suggest that meaningful state-level differences in Child HCAHPS performance could be found if performance were measured.