Academic Pediatrics Supplement Looks at Quality Improvement in Children’s Health Care
The first part of a new AHRQ-funded supplement to Academic Pediatrics features research and lessons learned on quality improvement efforts in children’s health care. The supplement, which was published as open access online on November 21 and co-edited by Denise Dougherty, Ph.D., of AHRQ, includes a study that evaluated early experiences of participants in quality improvement collaboratives in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program in nine states. According to the study, collaborative participants valued various aspects of support in developing patient-centered medical home capacity and improving quality improvement performance, but the volume of change-inducing initiatives and information was often overwhelming. This study was coauthored by Cindy Brach of AHRQ along with Kelly J. Devers and Leslie Foster, both of whom are members of the grant program’s national evaluation team. In addition, Dougherty co-authored an overview, along with Marie C. McCormick, M.D, of Harvard School of Public Health, and John Patrick T. Co, M.D., of MassGeneral Hospital for Children, that highlights the approaches to conducting research to evaluate the context-sensitive effectiveness of quality improvement interventions described in detail in four articles featured in the supplement. The methods articles stem from presentations at the Academic Pediatric Association annual quality improvement research methods conferences also supported by AHRQ. Select to access more information on AHRQ’s role in CHIPRA or on the CHIPRA Quality Demonstration Grant projects and national evaluation. A second supplement on education in quality improvement is expected to be published early next year in Academic Pediatrics.
Children's Health Insurance Program Reauthorization Act (CHIPRA) | Agency for Healthcare Research & Quality (AHRQ)
Children's Health Insurance Program Reauthorization Act (CHIPRA)
CHIPRA Children's Health Care Quality Measurement and Improvement ActivitiesThe Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 was signed into law by President Obama in January 2009. Since that time, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) have been working together to implement selected provisions of the legislation related to children's health care quality.
Title IV of CHIPRA promises a new day for children's health care quality, especially for those 39 million children covered by Medicaid and CHIP programs. We are pleased to share the latest information about how our work is progressing and to provide key stakeholders an opportunity to share their views on this critical endeavor.
Please send comments to CHIPRAqualitymeasures@ahrq.hhs.gov.
Improving the Initial Core Set: The CHIPRA Pediatric Quality Measures Program
National Evaluation of the CHIPRA Quality Demonstration Grant Program
Model Children's EHR Format
Institute of Medicine Report
Identification of the Initial Core Set of Children's Health Care Quality Measures
More AHRQ Resources
Centers for Medicare & Medicaid Services
OverviewThe Agency for Healthcare Research and Quality (AHRQ) is working in collaboration with CMS, the CHIPRA Federal Quality Workgroup, and external experts to fulfill a number of requirements under Title IV of CHIPRA:
- Identify an initial core set of children's health care quality measures for voluntary use by Medicaid and CHIP programs (select for a list of final, posted measures and archived materials).
- Implement the CHIPRA Pediatric Quality Measures Program using grants and contracts. The PQMP will contribute to the CHIPRA-required identification of improved core children's health care quality measures for use by Medicaid and CHIP and other public and private programs, providers, plans, and patients.
- Evaluate CMS's Quality Demonstration project awards and create a Model Children's Electronic Health Record Format.
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Improving the Initial Core Set: The CHIPRA Pediatric Quality Measures ProgramAs a followup to identifying the initial core measure set of children's health care quality measures, CHIPRA required establishment of a Pediatric Quality Measures Program (PQMP) of grants and contracts. Results of the PQMP are to be used to develop future enhanced and improved core sets of measures and provide for development of new measures as needed. To meet these requirements, AHRQ has awarded grants for the CHIPRA Pediatric Healthcare Quality Measures Program Centers of Excellence and a contract for a Coordinating and Technical Assistance Center.
AHRQ's National Advisory Council on Healthcare Research and Quality has appointed a Subcommittee on Quality Measures for Children's Healthcare to review publicly nominated and Centers of Excellence (CoE)-developed children's health care quality measures for potential inclusion in improved core measure sets and for other CHIPRA purposes.
As required by CHIPRA, CMS advised State Medicaid and CHIP programs of changes to the initial core set. Select http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-13-002.pdf (Plugin Software Help) for the letter to State health officials (SHO letter), which includes a link to a background paper, Recommendations to Improve Children's Health Care Quality Measures: Background Report on the 2012 Process.
Select for the candidate measure submission form (CPCF) used in 2012 by COEs to submit measures and by the Subcommittee on Quality Measures for Children's Healthcare (SNAC) to assess submitted measures. The CPCF was approved by OMB in December 2012.
2013 Activities: Measure RetirementIn 2013, AHRQ, CMS, and the 2013 AHRQ SNAC collaborated in an effort to identify measures from the initial child core set published in 2009 for potential retirement. Periodic reassessment of measures’ importance, scientific acceptability, feasibility, and usability is part of a life-cycle approach to quality measurement. AHRQ, CMS, and the 2013 SNAC identified criteria that could be used to assess potential measures for retirement and an analytic approach to getting and assessing detailed information for assessing 20 of the initial child core measures against the agreed-upon criteria. AHRQ and its contractor RTI gathered, interpreted, and conveyed information to the 2013 SNAC, and the SNAC used the information in two rounds of scoring using a modified Delphi approach. SNAC recommendations were communicated to CMS in late October. CMS will take the recommendations into consideration as it prepares to inform States and the public about improvements to the child core set by January 2014 as required by the CHIPRA legislation.
CHIPRA PQMP PublicationsThe following PQMP-related articles have been published recently:
- Development of the PROMIS® Pediatric Global Health (PGH-7) Measure
- Continuity of Public Insurance Coverage: A Systematic Review of the Literature
- National Quality Measures for Child Mental Health Care: Background, Progress, and Next Steps
- Pediatric Readmission Prevalence and Variability Across Hospitals
- Quality Measurements in Pediatrics: What Do They Assess?
- Pediatric Health Care Quality Measures: Considerations for Pharmacotherapy
http://www.ncbi.nlm.nih.gov/pubmed/23918049 (PDF File, 137 KB; Plugin Software Help).
|Feb. 2009||CHIPRA signed into law.|
|Dec. 2009||The initial core set of children's health care measures published in Federal Register.|
|Dec. 2010||Federal Register notice published December 3: Priority-setting process for development and enhancement of children's health care quality measures. Submission period ends January 14.|
|Feb. 2011||CMS posted technical specifications for the initial core set of children's health care measures for reporting by State Medicaid and CHIP programs.|
|March 2011||Centers of Excellence Awarded.|
|Sept. 2011||Expert panel discusses criteria by which to evaluate children's health care quality measures, and required documentation to demonstrate how criteria are met (September 18).|
|Feb. 2012||Federal Register notice published February 24: "Request for Nominations of Children's Healthcare Quality Measures for Potential Inclusion in the CHIPRA 2013 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP." Submission period ends April 24.|
|April 2012||Federal Register notice published April 18 with request for comments on the "CHIPRA Pediatric Quality Measures Program Candidate Measure Submission Form" (to nominate measures for potential inclusion in future Improved Core Sets of Health Care Quality Measures for Medicaid/CHIP). This Measure Submission Form indicates the proposed set of attributes about a pediatric quality measure that would be considered by the Subcommittee on Quality Measures for Children's Healthcare of AHRQ's National Advisory Council (NAC). Submission period ends June 18.|
Period ends for submitting nominations of Children's Healthcare Quality Measures for Potential Inclusion in the CHIPRA 2013 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP (April 24).
|June 2012||Second Annual National Medicaid and CHIP Quality Conference in Baltimore, Maryland (PDF File, 40 KB; Plugin Software Help) (June 14-15).|
Period ends for submitting comments on the "CHIPRA Pediatric Quality Measures Program Candidate Measure Submission Form" (June 18).
|Sept. 2012||SNAC in-person meeting held September 12; select for transcript. SNAC recommends CHIPRA 2013 Improved Core Set of Health Care Quality Measures for Voluntary Use by Medicaid/CHIP and for other CHIPRA purposes to NAC (September 12).|
|Jan. 2013||CMS makes recommendations to the core set of children's quality measures for voluntary use by Medicaid and CHIP.|
Letter to State Health Officials (SHO letter) (PDF File, Plugin Software Help)
Recommendations to Improve Children's Health Care Quality Measures: Background Report on the 2012 Process
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National Evaluation of the CHIPRA Quality Demonstration Grant ProgramIn February 2010, CMS awarded grants to 10 States to identify effective, replicable strategies to enhance quality of care and improve care delivery for children enrolled in Medicaid and CHIP. Through partnerships and collaboration, 18 States are implementing 51 projects in five general categories: the use of quality measures, health information technology applications, provider-based delivery models, use of a model format for pediatric electronic health records, and other innovative approaches to improve quality.
AHRQ is leading the national evaluation of this program. Select for more information about the National Evaluation of the Quality Demonstration Grant Program.
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Model Children's EHR FormatThe Children's EHR Format was authorized by the 2009 Children's Health Insurance Program Reauthorization Act (CHIPRA) and developed by AHRQ in close collaboration with CMS. The Format was developed to bridge the gap between the functionality present in most EHRs currently available and the functionality that would more optimally support the care of children. Specifically, the Format provides information to EHR system developers and others about critical functionality, data elements, and other requirements that need to be present in an EHR system to address health care needs specific to children, especially those enrolled in Medicaid or the Children's Health Insurance Program (CHIP).
For more information about the Children's EHR Format or to access the Format, go to http://healthit.ahrq.gov/ChildehrFormat.
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Institute of Medicine ReportThe CHIPRA legislation called for the Institute of Medicine (IOM) to study and prepare a report on efforts to measure child health status and the quality of health care for children across the pediatric age span.
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Identification of the Initial Core Set of Children's Health Care Quality MeasuresCHIPRA required that an initial core set of children's health care quality measures for voluntary use by Medicaid and CHIP programs be posted for public comment by January 1, 2010. The legislation required that the measure set:
- Be drawn from measures already in use to measure children's health care quality.
- A full array of health care quality domains.
- A broad array of health care services affecting children.
- Children of all ages, all children's health care settings and providers.
- Be evidence-based.
- Be understandable to families.
- Allow identification of disparities by race, ethnicity, socioeconomic status, and special health care need status.
AHRQ organized a publicly transparent, evidence-informed process to identify the initial core set of measures for consideration by CMS and the Secretary of HHS. The SNAC submitted a report to AHRQ (select for the SNAC Report detailing their work). The measure set was posted for public comment by the legislative deadline. In February 2011, CMS posted technical specifications for the measures to be used by State programs.
At AHRQ's request, SNAC Co-Chair Rita Mangione-Smith prepared a thoughtful overview and evaluation of the Subcommittee's work in identifying the initial core set of quality measures, including a number of "lessons learned" along the way that could benefit similar future endeavors. The report, Lessons Learned from the Process Used to Identify an Initial Core Quality Measure Set for Children's Health Care in Medicaid and CHIP, is now available.
Additional reports, meeting transcripts, and other documents pertaining to the SNAC and the process of identifying the initial core set of measures are available. (Select Archived Materials.)
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More AHRQ ResourcesChild Health Care Quality, Medicaid, and CHIP
- Child & Adolescent Health
- Child Health Insurance Research Initiative (CHIRI™)
- Model Children's EHR Format: Frequently Asked Questions
- National Healthcare Quality Report and National Healthcare Disparities Reports
- Selected findings on child and adolescent health care from the 2010 National Healthcare Quality and Disparities Reports
- National Quality Measures Clearinghouse (NQMC)
- Pediatric Quality Indicators
- Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
- Technical Assistance for Health Information Technology and Health Information Exchange in Medicaid and CHIP
- MEPS Topics: Children's Health; reports and data files from AHRQ's Medical Expenditure Panel Survey
- CMS CHIPRA Web site
Second Annual Multi-State Health IT Collaborative for E-Health Conference, February 8-9, 2010
Handouts and an audio recording of the HITECH conference call are available for download at http://www.cms.gov/EHRIncentivePrograms under "Related Links Inside CMS."
- CMS Technical Specifications (PDF File, 842 KB; Plugin Software Help).
- CMS Technical Assistance
Current as of November 2013Internet Citation: Children's Health Insurance Program Reauthorization Act (CHIPRA). November 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/chipra/index.html
National Evaluation of the CHIPRA Quality Demonstration Grant Program
Find information and evaluation reports on State demonstration projects funded by the Children’s Health Insurance Program Reauthorization Act to improve the quality of health care for children enrolled in Medicaid and CHIP.
In February 2010, the Centers for Medicare & Medicaid Services (CMS) awarded 10 grants, funding 18 States, to improve health care quality and delivery systems for children enrolled in Medicaid and the Children's Health Insurance Program (CHIP). Funded by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), the Quality Demonstration Grant Program aims to identify effective, replicable strategies for enhancing quality of care for children. The Agency for Healthcare Research and Quality is leading the national evaluation of this program.
As a group, the 18 demonstration States are implementing 51 projects in five general categories:
- Using quality measures to improve child health care.
- Applying health information technology for quality improvement.
- Implementing provider-based delivery models.
- Investigating a model format for pediatric electronic health records (EHRs).
- Assessing the utility of other innovative approaches to enhance quality.
- The projects that each demonstration State is implementing (select Learn About the Demonstration States).
- The specific projects being implemented under each of the five categories (select one of the five specific strategies for quality improvement, such as Using the Core Set of Children's Quality Measures).
- Reports that the national evaluation team and the State-specific evaluation teams have produced on specific evaluation topics and questions (select Reports & Resources).
- Our approach to the national evaluation, including the evaluation design and methods (select More about the Evaluation).
- New findings, events, and publications from the national and State evaluations (select What's New?).
To contact the team that is conducting the national evaluation of the CHIPRA Quality Demonstration Grant Program, send an email to CHIPRADemoEval@ahrq.hhs.gov.
Please note: This Web site uses the term "national evaluation" to distinguish this evaluation of the entire demonstration program from evaluations commissioned or undertaken by grantees. The word "national" should not be interpreted to mean that findings are representative of the United States as a whole.
Current as of January 2013Internet Citation: National Evaluation of the CHIPRA Quality Demonstration Grant Program. January 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/chipra/demoeval/index.html
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