The CHIPRA Pediatric Quality Measures Program: Health Information Technology and Patient Safety

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Slide 1

The CHIPRA Pediatric Quality Measures Program: Health Information Technology and Patient Safety

Edwin Lomotan, MD, FAAP
Office of Extramural Research, Education, and Priority Populations
AHRQ Annual Conference
September 10, 2012

Slide 2

Learning Objectives

• Identify the patient safety measures being developed by the Centers of Excellence.
• Describe challenges to developing pediatric quality measures designed for implementation within electronic health records.

Slide 3

CHIPRA

• Children's Health Insurance Program Reauthorization Act of 2009.
• Title IV—Strengthening Quality of Care and Health Outcomes:
  • Section 401 (a)—Development of Child Health Quality Measures for Children Enrolled in Medicaid or CHIP:
    • Initial core set of measures.
  • Section 401 (b)—Advancing and Improving Pediatric Quality Measures:
    • Creation of the Pediatric Quality Measures Program.

Slide 4

CHIPRA—Initial Core Set

• Identified by AHRQ National Advisory Council Subcommittee on Children's Healthcare Quality Measures for Medicaid and CHIP.
• Required consideration of existing measures.
• 24 recommended measures covering a wide range of topics and ages.
• Released December 2009.

Slide 5

Initial Core Set: Summary

• Prevention and health promotion:
  • Prenatal/perinatal (4).
  • Immunizations (2).
  • Screening (3).
  • Well child care visits (3).
  • Dental (1).
• Management of acute conditions:
  • Appropriate use of antibiotics (2).
  • Dental (1).
  • Emergency department (1).
  • Inpatient safety (1): CLABSI [catheter-associated blood stream infection] rates in PICU and NICU [pediatric and neonate ICU].
• Management of chronic conditions:
  • Asthma (1).
  • ADHD (1).
  • Mental health (1).
  • Diabetes (1).
• Family experiences of care:
  • CAHPS®, child version (1).
• Availability:
  • Children and adolescent access to PCPs (1).

Slide 6

Pediatric Quality Measures Program (PQMP)

• Purpose:
  • To identify new recommended core sets annually beginning January 1, 2013.
  • To fill gaps left by the initial core set.
• Core measure requirements:
  • Full range of services, conditions, and ages.
  • Enable assessment of health care disparities.
  • Leverage health IT and collected in a standard format.
  • For broad public and private use.
  • Publicly-informed process.

Slide 7

PQMP—Components

• 7 Centers of Excellence:
  • Cooperative agreement grants (U18).
  • Each is a consortium of academic institutions, State partners, consumers, and others.
• 2 CMS Quality Demonstration Grantee States (IL, MA).
• Coordinating and Technical Assistance Center contract (RTI).
• AHRQ-CMS collaboration.
• Public input.
• 4 year program beginning March 2011.

Slide 8

Getting to Improved Core Sets

Image: A circle is divided into three equal sections captioned "Receive measures (Spring)," "Assess measures (Summer - Fall)," and "Recommend measures (Winter)." The circle is rimmed with arrows, indicating that this is a cyclical process. Above the first two sections is an overarching arrow captioned "Centers of Excellence submissions." A note on the second sectioned reads "Subcommittee to AHRQ's National Advisory Council (SNAC)." Between the third and first sections is another note, reading "Improved core set (annually on January 1st)." The logo for the AHRQ-CMS CHIPRA Pediatric Quality Measures Program is in the lower right-hand corner.

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Patient Safety Measure Assignments

• Global patient safety tool.
• Imaging for seizures and headache.
• Medication reconciliation.
• Psychotropic medication use.
• Alcohol and substance use screening, diagnosis, treatment, and follow up.
• Temperature on admission to NICU.
• Pediatric Intensive Care.

Slide 10

Health IT: CHIPRA and Meaningful Use

• 5 measures appear in both Meaningful Use and in the CHIPRA initial core set:
  • Weight assessment/counseling for children and adolescents.
  • Childhood immunization status.
  • Chlamydia screening for women.
  • Appropriate testing for children with pharyngitis.
  • Follow-up care for children prescribed ADHD medication.

Slide 11

PQMP Informatics

• Presentation by NQF on the Quality Data Model at kick-off meeting.
• Informatics Workgroup.
  • Co-chaired by Marjorie Rallins (AMA-PCPI) and Aldo Tinoco (NCQA).
• Working with ONC and CMS.
  • Measures for potential use in future stages of Meaningful use.

Slide 12

Moving the PQMP and Health IT Forward

• Sample challenges:
  • Re-tooling vs. developing de novo measures.
  • Applying standards vs. conventions.
  • Testing for validity and feasibility.
  • Realizing that e-measurement depends heavily on local implementation.
  • Getting to common value sets.
  • Building an evidence base and eventually a set of best practices.
  • Staying focused on kids.

Slide 13

Resources

• AHRQ CHIPRA:
  • https://www.ahrq.gov/chipra/.
• CHIPRA Initial Core Set and Centers of Excellence Measure assignments:
  • https://www.ahrq.gov/chipra/pqmpmeasures.htm.
• CMS CHIPRA:
  • http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Childrens-Health-Insurance-Program-CHIP/CHIPRA.html.
  • http://www.insurekidsnow.gov.
• Model children's EHR format:
  • https://www.ahrq.gov/chipra/ehrformatfaq.htm.

Slide 14

• Questions?
  • edwin.lomotan@ahrq.hhs.gov
• 2012 SNAC Meeting:
  • Wednesday, September 12, 2012.
  • Bethesda Marriott Hotel, 5151 Pooks Hill Road, Bethesda, Maryland 20814.
  • Begins at 7:45 am.