The CHIPRA Pediatric Quality Measures Program:

Health Information Technology andPatient Safety

Edwin Lomotan, MD, FAAPOffice of Extramural Research, Education, and

Priority PopulationsAHRQ Annual Conference

September 10, 2012

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

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

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

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 rates in PICU and NICU

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)

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

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

Getting to Improved Core Sets

Assess measures

(Summer – Fall)

Recommend measures (Winter)

Receive measures (Spring)

Centers of Excellence submissions

Improved core set (annually on January 1st)

Subcommittee to AHRQ’s National Advisory Council (SNAC)

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

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

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

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

Resources

AHRQ CHIPRA– http://www.ahrq.gov/chipra/

CHIPRA Initial Core Set and Centers of Excellence Measure assignments– http://www.ahrq.gov/chipra/pqmpmeasures.htm

CMS CHIPRA– http://www.medicaid.gov/Medicaid-CHIP-Program-Informatio

n/By-Topics/Childrens-Health-Insurance-Program-CHIP/CHIPRA.html

– http://www.insurekidsnow.gov/

Model children’s EHR format– http://www.ahrq.gov/chipra/ehrformatfaq.htm

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