CHIPRA Pediatric Quality Measures Program
Quality Measures
The following two tables list children's health care quality measures from the AHRQ-CMS Pediatric Quality Measures Program (PQMP). Table 1 lists available measures that have been developed by PQMP grantees. The list will include links to brief measure fact sheets, as the fact sheets become available. Table 2 lists measure topics for measures in development by PQMP Centers of Excellence grantees.
For more information on any of the measures, please contact AHRQChipraqualitymeasures@ahrq.hhs.gov, or you may send an Email to the grantee contact noted on the topic factsheet.
Table 1. Available Measures Developed by PQMP Grantees
| Measure Category / Measure Developer / Brief Measure Label / Fact Sheet Availability / Endorsement or Recognition | Data Sources | Care Setting | Measure Numerator | Measure Denominator |
|---|---|---|---|---|
| Perinatal Care (Services for Delivery of Healthy Newborns) | ||||
| PMCoE | ||||
| Episiotomy (overuse) | Electronic medical record | Inpatient | Patients who underwent an episiotomy | All patients, regardless of age, who gave birth vaginally (without shoulder dystocia), during a 12-month period |
| Behavioral risk assessment (for pregnant women) | Electronic medical record | Ambulatory | Patients who received all behavioral health screening risk assessments at the first prenatal visit: depression, alcohol use, tobacco use, drug use, intimate partner violence. | All patients, regardless of age, who gave birth during a 12-month period seen at least once for prenatal care. |
| BMI assessment and recommended weight gain (for pregnant women) | Electronic medical record | Ambulatory | Patients who had a BMI value recorded and were counseled on recommended weight gain during pregnancy at first prenatal care visit. | All patients, regardless of age, who gave birth during a 12-month period seen at least once for prenatal care. |
| Cesarean delivery for nulliparous women (appropriate use) | Electronic medical record | Inpatient | Patients who had a cesarean delivery. | All nulliparous patients, regardless of age, who gave birth during a 12-month period to a live singleton in vertex presentation at or beyond 37 weeks of gestation. |
| Postpartum followup and care coordination | Electronic medical record | Ambulatory | Patients receiving the following at a postpartum visit: Breast feeding evaluation and education, including patient-reported breast feeding; postpartum depression screening; postpartum glucose screening for gestational diabetes patients; and family and contraceptive planning. | All patients, regardless of age, who gave birth during a 12-month period seen for postpartum care visit before or at 8 weeks of giving birth. |
| Child Clinical Preventive Services | ||||
| NCINQ | ||||
| Tobacco use and help with quitting among adolescents | Paper medical record or electronic medical record | Ambulatory | Adolescents with documentation that the adolescent is not a tobacco user, OR the adolescent is a tobacco user AND received advice, counseling, referral OR is in treatment. | Adolescents who turn 12 through 20 years of age during the measurement year. |
| Sexual activity status among adolescents | Medical record (paper or electronic) | Ambulatory | Adolescents with: Current or past sexual activity status; Current or past diagnosis of an STI; Use of birth control, either non-hormone based or prescribed with indication for pregnancy prevention. | Adolescents who turn 12 through 20 years of age during the measurement period. |
| Management of Acute Conditions | ||||
| CAPQuaM—Temperatures of LBW Newborns | ||||
| Distribution of temperatures for LBW admitted to Level 2 or higher nurseries in first 24 hours of life | Hybrid of medical records (paper or electronic) and administrative claims | Inpatient | Continuous variable—Parameter of interest is the neonate's temperature taken upon admission to a Level 2 or higher nursery. | All infants born in a medical facility with birth weights less than 2500 grams and admitted to a Level 2 or higher nursery within 24 hours of birth. |
| Thermal condition for LBW neonates admitted to Level 2 of higher nurseries in first 24 hours of life | Hybrid of administrative claims data and medical records (paper or electronic) data. | In-patient | Number of children whose first temperature after arrival to the Level 2 or higher nursery falls within the following criteria: Cold (< or =34.5); Very cool (34.51-35.50), Cool (35.51- 36.50); Euthermic (36.51-37.50); and Overly warm (> 37.5). | All infants born in a medical facility less with birthweights less than 2500 grams and admitted to a Level 2 or higher nursery within 24 hours of birth+G47. |
| Timely temperatures upon arrival in Level 2 or higher nurseries for LBW neonates | Administrative data (e.g. claims data), paper medical record, EMR | In-patient | Live-born neonates with a birthweight less than 2500 grams admitted to a Level 2 or higher nursery who have their body temperature taken within 15 minutes of arrival to the nursery and for whom this temperature is documented in the medical record. | All infants born in a medical facility with birthweights less than 2500 grams and admitted to a level 2 or higher nursery in the first 24 hours of life, other than those excluded. |
| Timely temperature for all low birthweight neonates | Administrative data (e.g. claims data), paper medical record, electronic medical record | In-patient | Neonates under 2500 grams who are born in a medical facility | All newborns born in a medical facility less with birthweights less than 2500 grams, other than those excluded. |
| Management of Chronic Conditions | ||||
| COE4CCN | ||||
| Pediatric Medical Complexity Algorithm | Administrative data | Ambulatory / Inpatient | NA | NA |
| PMCOE—ADHD Care | ||||
| ADHD followup care | Administrative (claims) data | Ambulatory | Patients who attended at least one ADHD followup care visit within the calendar year. | All patients aged 4 through 18 years with a diagnosis of ADHD (and no psychiatric comorbidities). |
| Accurate ADHD diagnosis | Medical record (paper or electronic) | Ambulatory / inpatient | Patients whose diagnosis of ADHD was based on a clinical exam with a physician that included clinical practice guideline recommended assessment using a validated tool, confirmation, or direct assessment of the patient. | All patients ages 4 through 18 years with a diagnosis of ADHD. |
| Behavior therapy as first-line treatment for preschool-aged children | Paper medical record, electronic medical record | Ambulatory / Inpatient | Patients for whom ADHD-focused evidence-based behavior therapy was prescribed as first-line treatment. | All patients aged 4 through 5 years with a diagnosis of ADHD. |
| CAPQUAM—Emergency Room Use by Children with Asthma | ||||
| CAPQuaM PQMP Asthma I : Rate of emergency department visit use for children managed for persistent asthma | Administrative data | Ambulatory | Number of visits to the emergency department by children who are being managed for persistent asthma. Date and number of all emergency visits with a primary or secondary diagnosis of asthma. | The denominator represents the person time (calculated monthly in child-months) contributed by children ages 2—21 who meet the criteria for persistent asthma for that month's assessment period and have been continuously enrolled in the index plan for at least 2 consecutive months immediately preceding the reporting month. |
| CAPQuaM PQMP Asthma II: Distribution of emergency department visit use for children managed for persistent asthma | Administrative data and race / ethnicity data OR zip code data | Ambulatory | Two count measures and two distributions. The counts are the number of unique children age 2-21 who meet the criteria for persistent asthma and the number who have at least one visit to the emergency department. The distributions are: the distribution of the number of ED visits that each child who contributed to the numerator had; and the number of months that each child in the numerator contributed to the numerator. | N/A |
| CAPQuaM PQMP Asthma III: Primary care connection prior to emergency department visits for children with identifiable asthma | Administrative data | Ambulatory | Evidence of connection to the primary care medical system prior to first ED visit and / or hospitalization that has a primary or secondary diagnosis of asthma among children whom our specifications identify with asthma. | All first ED visits and / or hospitalizations, in which asthma was a primary or secondary diagnosis, identified using the specifications provided in Section II, in children who are eligible because they meet the criteria for identifiable asthma and have been enrolled for the 6 consecutive months prior to the ED visit/admission. |
| CAPQuaM PQMP Asthma IV: Primary care connection after emergency department visits for asthma | Administrative data (e.g. claims data) | Ambulatory | 1. Visit(s) to a primary care provider that occurred within 14 days following the ED visit 2. Visit(s) to a primary care provider that occurred within 30 days following the ED visit 3. Have at least one fill of an asthma controller medication within 2 months after the ED visit (including the day of visit) | All ED visits in which asthma was a primary or secondary diagnosis, identified using the specifications provided in Section II, in children who are continuously enrolled for at least the 2 months following the ED visit. |
| NCINQ—Use of antipsychotics | ||||
| Use of first-line psychosocial care for children and adolescents on antipsychotics | Administrative data (e.g., claims data) | Ambulatory | Documentation of psychosocial care during the 121-day period from 90 days prior to the date on which a new antipsychotic prescription was dispensed to 30 days after the date on which a new antipsychotic prescription was dispensed. | Children age 1 to 20 years with a new prescription of an antipsychotic medication during the measurement year. |
| Followup visit for children and adolescents on antipsychotics | Administrative data (e.g., claims data) | Ambulatory | One or more followup visits with a practitioner with prescribing authority, within 30 days of the date on which a new antipsychotic prescription was dispensed. | Children age 1 to 20 years with a new prescription of an antipsychotic medication during the measurement year. |
| Metabolic screening for children and adolescents newly on antipsychotics | Administrative data (e.g., claims data) | Ambulatory | One or more tests for blood glucose and one or more tests for cholesterol in the 106-day period from 90 days prior to 15 days after the new start of an antipsychotic medication. | Children age 1 to 20 years with a new prescription of an antipsychotic medication during the measurement year. |
| Metabolic monitoring for children and adolescents on antipsychotics | Administrative data (e.g., claims data) | Ambulatory | At least one test for blood glucose or HbA1c AND at least one test for LDL-C or cholesterol during the measurement year. | Children age 1 to 20 years who have had two or more antipsychotic medications dispensed on separate dates of service during the measurement year. |
| Use of multiple concurrent antipsychotics in children | Administrative data (e.g., claims data) | Ambulatory | Those on two or more concurrent antipsychotic medications for at least 90 days during the measurement year. | Children age 0 to 20 years on any antipsychotic medication during the measurement year, with at least 3 months of continuous health plan eligibility for medical and pharmacy benefits. Age stratification: 0-5 years, 6-11 years, 12-17 years, 18-20 years. |
| Children on higher than recommended doses of antipsychotics | Administrative data (e.g., claims data) | Ambulatory | Received two or more antipsychotic medication prescriptions with higher than recommended doses. | Children age 0 to 20 years on an antipsychotic medication during the measurement year, with at least 3 months of continuous health plan eligibility for medical and pharmacy benefits. Age stratification: 0-5 years, 6-11 years, 12-17 years, 18-20 years. |
| Use of antipsychotic medications in very young children | Administrative data (e.g., claims data); Accepted as a HEDIS measure | Ambulatory | Those on any antipsychotic medication during the measurement year. | Children age 0 to 5 years during the measurement year. Age stratification: Less than 2 years, 2-3 years, 4-5 years. |
| Q-METRIC—Sickle Cell Treatment | ||||
| Appropriate outpatient blood testing | Paper and electronic medical records | Ambulatory | Children who had a pulse oximetry reading, complete blood count, and reticulocyte count as part of outpatient care; 3 rates will be reported, one for each test type. | Children ages 0 to 5 who have SCD. |
| Anticipatory guidance for pain management | Paper and electronic medical records | Ambulatory | Children who received anticipatory guidance regarding the prevention and/or management of pain as part of outpatient care during the measurement year. | Children identified as having SCD. |
| Anticipatory guidance for prevention of severe fever and infection | Paper and electronic medical records | Ambulatory | Children who received anticipatory guidance regarding the prevention and/or management of fever and severe infection as part of outpatient care during the measurement year. | Children identified as having SCD. |
| Anticipatory guidance for the prevention of stroke | Paper and electronic medical records | Ambulatory | Children who received anticipatory guidance regarding identification, prevention and/or management of stroke/silent infarcts as part of outpatient care during the measurement year. | Children identified as having SCD. |
| Anticipatory guidance regarding school attendance | Paper and electronic medical records | Ambulatory | Children who received anticipatory guidance regarding school attendance as part of outpatient care during the measurement year. | Children identified as having SCD. |
| Anticipatory guidance for prevention of splenic complications | Paper and electronic medical records | Ambulatory | Children who received anticipatory guidance regarding the prevention and/or management of splenic complications as part of outpatient care during the measurement year. | Children identified as having SCD. |
| Anticipatory guidance regarding hydroxyurea treatment | Electronic medical record | Ambulatory | Children who received anticipatory guidance regarding the risks and benefits of treatment with hydroxyurea as part of outpatient care during the measurement year. | Children identified as having SCD. |
| HgB S monitoring at time of transfusion (chronic transfusion) | Paper and electronic medical records | Children who received monitoring of HgB S levels at the time of each transfusion. | Children identified as having SCA who received transfusion(s). | |
| Appropriate ED blood testing | Electronic medical record | ED | Children who had a pulse oximetry reading, complete blood count, reticulocyte count, and blood culture within 60 minutes of initial contact. Four rates will be reported, one for each test type. | Children identified as having SCD who presented to the ED with fever. |
| Appropriate ED fever management | Electronic medical record | ED | Children who received parenteral broad-spectrum antibiotic treatment within 60 minutes of initial contact. | Children identified as having SCD who presented to the ED with fever. |
| Appropriate ED pain assessment | Electronic medical record | ED | Children who had a pain assessment within 30 minutes of initial contact. | Children identified as having SCD who presented to the ED with an acute pain episode during the measurement year. |
| Appropriate ED pain management | Electronic medical record | ED | Children who had parenteral analgesic within 60 minutes of initial contact, and a pain assessment within 30 minutes of analgesic administration. Two rates will be reported, one for administration and one for followup assessment. | Children identified as having SCD who presented to the ED with severe pain during the measurement year. |
| Satisfaction with hematologist care | Survey | Parents who respond Agree or Strongly Agree to the question, Over the past 12 months, I have been satisfied with the overall care from my child's hematologist. | Parents of children with SCD. | |
| Satisfaction with ED care | Survey | ED | Parents who respond Agree or Strongly Agree to the question, Over the past 12 months, I have been satisfied with the overall care my child received in the ED. | Parents of children with SCD. |
| Timeliness of confirmatory testing for sickle cell disease | State newborn screening data (denominator); administrative data (numerator) | Ambulatory | Number of children receiving confirmatory testing for SCD and communication of those results. Two rates will be reported. | The denominator is drawn from all SCD cases reported in a State's newborn screening program records within the measurement year. |
| Timeliness of antibiotic (penicillin) prophylaxis for children with SCD | Administrative (pharmacy) for numerator; State newborn screening data | Ambulatory | The number of eligible children who received appropriate antibiotic prophylaxis within 90 days of age. | The eligible population is drawn from all SCD cases reported in State NBS program records. |
| Appropriate antibiotic prophylaxis for children with sickle cell disease | Claims data | Ambulatory | Number of children ages 3 months through 4 years with SCD, continuously enrolled in Medicaid, who during the measurement year received preventive antibiotics for at least 300 days, and at least 350 days. | The number of children ages 3 months through 4 years with SCD, who were continuously enrolled in Medicaid during the measurement year. |
| Transcranial doppler ultrasonography screening for children with sickle cell disease | Claims data, paper medical record, electronic medical record | Ambulatory | The number of children ages 2 through 15 years of age with SCD who were continuously enrolled in Medicaid and who received TCD ultrasonography during the measurement year. | The number of children ages 2 through 15 years olf age with SCD who were continuously enrolled in Medicaid during the measurement year. |
| CEPQM—Hospital Readmissions | ||||
| Pediatric all-condition readmission measure pediatric | Hospital discharge (claims) data | Inpatient | Hospitalizations at general acute care hospitals for patients less than 18 years old that are followed by one or more readmissions to general acute care hospitals within 30 days. | Hospitalizations at general acute care hospitals for patients less than 18 years of age. |
| Lower respiratory infection readmission measure | Hospital discharge (claims) data | Inpatient | Hospitalizations at general acute care hospitals for LRI in patients less than 18 years of age that are followed by one or more readmissions to general acute care hospitals within 30 days. | Hospitalizations at general acute care hospitals for LRI in patients less than 18 years of age. Does not include mental health admissions or well newborns. |
| Patient Reported Outcomes (Health Outcomes and Patent Experiences of Care) | ||||
| CHOP | ||||
| Pediatric global health | Survey of children / caregivers | Ambulatory / inpatient—All care settings | The PGHM metric is a scale score—i.e., a single number that represents an individual's level of global health. For reporting purposes, we recommend calculation of mean values (or other measures of central tendency and dispersion) for a given group. Thus, the numerator will be the sum of measure scores across all individuals in a group. | For mean scores, the denominator is the sum of the number of individuals in the target population. |
| CEPQM | ||||
| Consumer Assessment of Healthcare Providers and Systems Hospital Survey—Child Version (Child HCAHPS) | Survey of parents of hospitalized children | Inpatient | The numerator is all individuals who return a completed survey. | The denominator for the survey is all patients who meet the following criteria: (1) Parents of children <18 years old; (2) Admission includes at least one overnight stay in the hospital; (3) Non-psychiatric MS-DRG / principal diagnosis at discharge; (4) Alive at time of discharge. |
| Transition from pediatric-focused to adult-focused health care | Survey of adolescents with a chronic health condition ('ADAPT') | All | Within each composite score, the numerator is the number of respondents with a positive response (item score of 1). | For survey items within each composite score, the denominator is the number of respondents for whom the item is scored as 0 or 1. |
| Duration of Enrollment and Coverage (Continuity of Coverage) | ||||
| CHOP | ||||
| Coverage in Medicaid and CHIP | Administrative data | Ambulatory / inpatient—All care settings | For Medicaid / CHIP standalone programs—summation of covered days for all children over an 18-month observation window. Calculated for CHIP separately. [Does not reflect transitions between programs] For jointly administered Medicaid and CHIP programs—summation of covered days for all children in either program, over an 18-month observation window. [Reflects transitions between Medicaid and CHIP] | The denominator may take on variations depending on the structure of a State's Medicaid and CHIP program or the ability to link data across independent programs. It should be noted that there are cases where within one State, M-CHIP and S-CHIP data may reside separately. For Medicaid / CHIP standalone programs—Summation of eligible days over an 18-month observation window, for all children appearing in Medicaid records at any point within the 18-month observation window or an 18-month look-back period. Calculated for CHIP separately. For jointly administered Medicaid and CHIP programs—summation of eligible days for all children appearing in Medicaid or CHIP records at any point within the 18-month observation window or an 18-month look-back period. |
| Duration of first observed enrollment | Administrative data | NA | For Medicaid / CHIP standalone programs—total number of children continuously enrolled in Medicaid at 6 months, 12 months, and 18 months after initial enrollment during a pre-specified observation period. For jointly administered Medicaid and CHIP programs or programs with the ability to link data across independent programs—total number of children continuously enrolled in Medicaid and CHIP at 6 months, 12 months, and 18 months after initial enrollment during a pre-specified observation period. | For Medicaid / CHIP standalone programs—total number of children newly enrolled in Medicaid during a 6, 12, or 18 month pre-specified observation period. Calculated for CHIP separately. For jointly administered Medicaid and CHIP programs or programs with the ability to link data across independent programs—total number of children newly enrolled in Medicaid or CHIP during a 6, 12, or 18 month pre-specified observation period. |
| Duration of newborn's first enrollment | Administrative data | NA | For Medicaid / CHIP standalone programs—total number of newborns continuously enrolled in Medicaid at 6 months, 12 months, and 18 months after enrollment during a pre-specified observation period. For jointly administered Medicaid and CHIP programs or programs with the ability to link data across independent programs—total number of newborns continuously enrolled in Medicaid and CHIP at 6 months, 12 months, and 18 months after enrollment during a pre-specified observation period. | For Medicaid / CHIP standalone programs—total number of newborns enrolled in Medicaid during a 6, 12, or 18 month pre-specified observation period. Calculated for CHIP separately. For jointly administered Medicaid and CHIP programs or programs with the ability to link data across independent programs—total number of newborns enrolled in Medicaid or CHIP during a 6, 12, or 18 month pre-specified observation period. |
| Availability of Services | ||||
| CAPQUAM | ||||
| High-risk deliveries at facilities with 24/7 in-house physician capable of safely managing labor and delivery, and performing a cesarean section, including an emergent cesarean section | Administrative data (e.g. claims data), survey—health care professional report | In-patient | Number of eligible deliveries (defined by a series of ICD and procedure codes) that occur in facilities with 24/7 in-house physician coverage that is dedicated to obstetrics, includes a physician capable of safely managing labor and delivery and performing a cesarean section, including an emergent cesarean section. | Overall number of eligible deliveries, as identified by: Class A—maternal diagnoses and comorbidities; Class B—delivery complications, fetal injury/compromise, or suboptimal infant diagnoses; or either Class A or B—(more details in technical specifications). |
| High-risk deliveries at facilities with 24/7 in-house physician coverage dedicated to the obstetrical service by a qualified anesthesiologist | Administrative data (e.g. claims data), survey—health care professional report | In-patient | Number of eligible deliveries (defined by a series of ICD and procedure codes) that occur in hospitals with 24/7 in-house physician coverage by an anesthesiologist who is qualified to provide obstetrical anesthesia and dedicated to the obstetrical service. | Overall number of eligible deliveries, as identified by (a) maternal diagnoses and comorbidities; (b) delivery complications, fetal injury or compromise, or suboptimal infant diagnoses; or (c) both. |
| High-risk deliveries at facilities with 24/7 in-house blood banking / transfusion services available | Administrative data (e.g. claims data), survey—health care professional report | In-patient | Number of eligible deliveries that occur in facilities with 24/7 in-house blood banking / transfusion services available to obstetrical patients. | Number of deliveries using as sources: Maternal and infant ICD-9 codes; and Maternal DRG, CPT codes, and revenue codes when available. |
| High-risk deliveries at facilities with level 3 or higher NICU services | Administrative data (e.g. claims data), survey—health care professional report | Inpatient | Number of eligible deliveries that occur in hospitals with Level 3 or higher NICU services on campus. | Number of deliveries using as sources: Maternal and infant ICD-9 codes; and Maternal DRG, CPT codes, and revenue codes when available. |
| Availability of OPD maternal fetal medicine and specialty care for women with high-risk pregnancies | Administrative claims data, and medical records for mother's race / ethnicity if needed | Ambulatory | The number of eligible (defined by a series of ICD and procedure codes) high-risk pregnant women who have the specified number of maternal fetal medicine or indicated subspecialty visits during their pregnancy (includes eight sub-measures). | Overall number of eligible qualifying high-risk pregnancies using the indicated look-back period. |
| Availability of multidisciplinary OPD care for women with high-risk pregnancies | Administrative claims data, and medical records for mother's race /ethnicity if needed | Ambulatory | The number of eligible (defined by a series of ICD and procedure codes) high-risk pregnant women seen as an outpatient by at least three different specified types of clinicians during their pregnancy. | Overall number of eligible qualifying high-risk pregnancies using the indicated look-back period. |
LEGEND: ADHD = attention deficit/hyperactivity disorder; BMI = body mass index; CAPQuaM = Mount Sinai Collaboration for Advancing Pediatric Quality Measures; CEPQM = Children's Hospital Boston Center of Excellence for Pediatric Quality Measurement; CHIPRA = Children's Health Insurance Program Reauthorization Act; CHOP = Center of Excellence at the Children's Hospital of Philadelphia/University of Pennsylvania; CPT = current procedure terminology; DRG = diagnosis-related group; DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; ED = emergency department; EMR = Electronic Medical Record; HCAHPS = Consumer Assessment of Healthcare Providers and Systems Hospital Survey; ICD-9 = International Classification of Diseases, Ninth Revision; LBW = low birthweight; LRI = lower respiratory infection; M-CHIP = Medicaid/Children's Health Insurance Program; MS/DRG = measure of severity/diagnosis-related group; NCINQ = National Collaborative for Innovation in Quality Measurement; NICU = neonatal intensive care unit; OPD = outpatient department; PGHM = pediatric global health measure; PMCoE = Pediatric Measurement Center of Excellence; PQMP = Pediatric Quality Measures Program; Q-METRC = Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium; SCD = sickle cell disease; STI = sexually transmitted infection; TCD = transcranial Doppler.
Current as of July 2014
Internet Citation: CHIPRA Pediatric Quality Measures Program: Quality Measures. July 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/chipra/factsheets/index.html
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