AHRQ Health IT Update: CHIPRA Quality Measures

Agency for Healthcare Research and Quality (AHRQ) sent this bulletin at 10/19/2012 08:05 AM EDT

Data from EHRs Provide Insights Into Quality of Children’s Care

A new AHRQ-funded study evaluates how to operationalize the measures of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 for computation within a single electronic health record (EHR). “Are Pediatric Quality Care Measures Too Stringent?” appeared in the October issue of the Journal of the American Board of Family Medicine. By applying relevant modifications to quality measure definitions, 16 of 24 nationally established quality measures were calculable, but information was gained or lost depending on how measures were specified. The authors of the study argue that overly strict adherence to measure definitions may overlook the true quality of care provided, especially in people who have sporadic patterns of receiving healthcare.

CHIPRA authorized the development of quality measures to evaluate care that children receive through the program. CHIPRA measures were designed to calculate care quality based on health insurance claims data. Claims data may not capture as many facets of patient care as electronic health records (EHRs). While claims data capture information generated during the period a patient is insured through a health plan, electronic health records capture information about patient care regardless of health insurance status.

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J Am Board Fam Med. 2012 Sep;25(5):686-93.

Are pediatric quality care measures too stringent?

Casciato A, Angier H, Milano C, Gideonse N, Gold R, Devoe J.

Source

the Department of Family Medicine, Oregon Health & Science University; Kaiser Permanente Northwest, Center for Health Research; and OCHIN Community Health Information Network, Portland, Oregon.

Abstract

Introduction: We aimed to demonstrate the application of national pediatric quality measures, derived from claims-based data, for use with electronic medical record data, and determine the extent to which rates differ if specifications were modified to allow for flexibility in measuring receipt of care.

METHODS:

We reviewed electronic medical record data for all patients up to 15 years of age with ≥1 office visit to a safety net family medicine clinic in 2010 (n = 1544). We assessed rates of appropriate well-child visits, immunizations, and body mass index (BMI) documentation, defined strictly by national guidelines versus by guidelines with clinically relevant modifications.

RESULTS:

Among children aged <3 10="10" 15="15" 2="2" 36="36" 3="3" 52.4="52.4" 60.8="60.8" 63="63" 91="91" a="a" age="age" aged="aged" among="among" attended="attended" before="before" birthday="birthday" bmi="bmi" by="by" children="children" completed="completed" date.="date." had="had" less="less" measurement="measurement" modifications="modifications" months="months" of="of" p="p" percentile="percentile" recorded="recorded" second="second" series="series" than="than" the="the" their="their" to="to" up="up" vaccination="vaccination" visits="visits" well-child="well-child" were="were" with="with" within="within" year.="year." years.="years." years="years">

CONCLUSIONS:

Applying relevant modifications to national quality measure definitions captured a substantial number of additional services. Strict adherence to measure definitions might miss the true quality of care provided, especially among populations that may have sporadic patterns of care utilization.