Background: In 2009, the Children's Health Insurance Program Reauthorization Act (CHIPRA) (Public Law 111-3) directed the Secretary of the U.S. Department of Health and Human Services (HHS) to identify by January 1, 2010, an initial core set of health care quality measures for voluntary use by Medicaid and the Children's Health Insurance Program (CHIP) programs. In addition, CHIPRA directed the Secretary to establish a CHIPRA Pediatric Quality Measures Program (PQMP).
The purposes of the PQMP go beyond use by Medicaid and CHIP programs; the PQMP is to improve and strengthen the initial core set of measures of health care quality established under CHIPRA; expand on existing pediatric quality measures used by public and private health care purchasers; and increase the portfolio of evidence-based consensus pediatric quality measures available to public and private purchasers of children's health care services, providers, and consumers.
In 2012, the following measures were recommended by the Secretary to be added in the Child Core Set: human papillomavirus (HPV) vaccine for female adolescents, medication management for people with asthma, and behavioral health risk assessment (for pregnant women). One measure was recommended for retirement: otitis media with effusion—avoidance of inappropriate systemic antimicrobials in children (ages 2–12). In 2013, as part of the annual review specified by CHIPRA to maintain the Child Core Set, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) considered whether retirement of any measures from the initial core set was warranted in light of any new evidence on the measures’ importance, scientific acceptability, feasibility, and usability. Twenty of the 24 measures in the initial core set were considered for retirement in 2013. Measures specific to dental care and consumer surveys were not considered for retirement. Measures considered for retirement included those related to prenatal care, well child visits, immunizations, asthma, emergency room use, preventive care screenings, access to care, diabetes, and mental health.
Methods: In 2013, the task of the National Advisory Council on Healthcare Research and Quality 2013 Subcommittee on Quality Measures for Children’s Healthcare for Medicaid and CHIP (SNAC) was to assess whether a measure was appropriate for retirement from the initial core set. AHRQ, CMS, the CHIPRA Coordinating and Technical Assistance Center (CCTAC; awarded to RTI International as part of the PQMP), and the SNAC worked collaboratively to define the categories of information and analyses needed to assess each measure on the selected criteria. With those definitions, AHRQ, CMS, and CCTAC developed a draft analytic report on each measure that included basic measure information and, where available, information on the following criteria: the importance of the measure (prevalence/incidence and cost/utilization related to the measure topic, as well as recent State and health plan performance on the measure), scientific acceptability (validity and reliability of the measure), feasibility (number of States reporting and data source), and usability (evidence of the ability to improve performance on the measure). In a process similar to that used in 2012, the SNAC used a modified Delphi approach and other scoring processes to assess measures and make retirement recommendations. CMS considered the SNAC recommendations and advised the Secretary of HHS on potential improvements to the initial core set.
Results: From the 20 measures reviewed, AHRQ identified three as having a clear recommendation for retirement: children and adolescent access to primary care practitioners, appropriate testing for children with pharyngitis, and annual pediatric hemoglobin (HbA1c) testing. After careful consideration, CMS is recommending that the Secretary retire the following measures: appropriate testing for children with pharyngitis, annual pediatric hemoglobin (HbA1c) testing, and annual percentage of asthma patients who are 2–20 years old with one or more asthma-related emergency department visits. The updates for the 2014 Child Core Set have been posted online by CMS in an Informational Bulletin dated December 19, 2013.
Conclusion: The second year of a collaborative public-private process met the CHIPRA legislative deadline of January 1, 2014, to make recommendations to improve the Child Core Set. The retirement recommendations take into account the legislative requirements of CHIPRA, help the Child Core Set reflect the most current information available and the most current standards of practice, and continue to identify areas of need for quality improvement.
