Elsevier

Academic Pediatrics

Volume 14, Issue 5, Supplement, September–October 2014, Pages S27-S32
Academic Pediatrics

Article
Developing Measures for Pediatric Quality: Methods and Experiences of the CHIPRA Pediatric Quality Measures Program Grantees

https://doi.org/10.1016/j.acap.2014.06.013Get rights and content

Abstract

Background

Monitoring quality is an important way of understanding how the health care system is serving children and families. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Pediatric Quality Measures Program (PQMP) funded efforts to develop and enhance measures to assess care for children and adolescents. We describe the processes used by the PQMP grantees to develop measures to assess the health care of children and adolescents in Medicaid and the Children's Health Insurance Program.

Methods

Key steps in the measures development process include identifying concepts, reviewing and synthesizing evidence, prioritizing concepts, defining how measures should be calculated, and measure testing. Stakeholder engagement throughout the process is critical. Case studies illustrate how PQMP grantees adapted the process to respond to the nature of measures they were charged to develop and overcome challenges encountered.

Results

PQMP grantees used varied approaches to measures development but faced common challenges, some specific to the field of pediatrics and some general to all quality measures. Major challenges included the limited evidence base, data systems difficult or unsuited for measures reporting, and conflicting stakeholder priorities.

Conclusions

As part of the PQMP, grantees were able to explore innovative methods to overcome measurement challenges, including new approaches to building the evidence base and stakeholder consensus, integration of alternative data sources, and implementation of new testing methods. As a result, the PQMP has developed new quality measures for pediatric care while also building an infrastructure, expertise, and enhanced methods for measures development that promise to provide more relevant and meaningful tools for improving the quality of children's health care.

Section snippets

Measures Development Process

Quality measures in the health care context are tools that characterize a structure, process or outcome relevant to quality goals such as safety, effectiveness, efficiency, and patient-centeredness.7 Measures serve purposes as varied as monitoring performance or describing trends, driving internal quality activities, or holding entities accountable. For the PQMP, CHIPRA called for measures for monitoring care of children enrolled in Medicaid/CHIP and in public and private health care

Case Studies

Producing measures that achieve or balance the desirable attributes is complex. The following examples illustrate how PQMP grantees developed measures for 2 topics. The cases describe some challenges that affect the field of pediatrics in particular and others that encumber quality measures in general.

Discussion

Despite their work in widely divergent content areas, these case studies followed similar steps in evidence review, measure specification, testing, and stakeholder engagement. These and other PQMP grantees demonstrated innovative approaches to address limits to the evidence base, overcome data challenges, and meaningfully engage stakeholders in developing the measures.

Conclusions

As illustrated, the PQMP grantees followed a common approach to measures development but varied it to meet the challenges of creating pediatric measures in complex medical domains. On the basis of this experience, we have several recommendations for future measures development. First, we need continued investment in research to generate the empirical evidence required for measures development. We are seeing some movement in this area: spurred by national incentive programs, broader adoption of

Acknowledgments

Supported in part by grants U18HS20518 (CAPQuaM), U18HS20513 (CEQM), U18HS20508 (CHOP CoE), U18HS20506 (COE4CCN), U18HS20503 (NCINQ), U18HS20498 (PMCoE), and U18HS20516 (Q-METRIC) from the AHRQ. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ.

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    The authors declare that they have no conflict of interest.

    Publication of this article was supported by the US Department of Health and Human Services and the Agency for Healthcare Research and Quality.

    The views expressed in this article are those of the authors and do not necessarily represent the views of the US Department of Health and Human Services or the Agency for Healthcare Research and Quality.

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