PQMP Measure Implementation and Quality Improvement Toolkits

The Pediatric Quality Measures Program (PQMP) 2.0 Centers of Excellence developed toolkits to facilitate measure implementation and quality improvement toolkits for select PQMP measures to support their dissemination and accelerate their implementation. Each toolkit contains resources such as measure specifications, driver diagrams, strategic roadmaps, communication flow diagrams, and improvement data.

The toolkits incorporate tools and resources developed through the grantees’ work on measure implementation and in their quality improvement efforts. They may be useful for State agencies, health plans, hospitals, and providers interested in implementing these measures.

A short description of each toolkit and the intended end-users is provided below, along with links to each toolkit. In addition, the PQMP Learning Collaborative developed an Implementation Science Roadmap that provides an overarching guide to measure implementation in support of broader dissemination and uptake of the toolkits.

• Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) Survey.
• Metabolic Monitoring for Children and Adolescents on Antipsychotics.
• Pediatric Asthma Emergency Department (ED) Use.
• Quality of Pediatric Hospital-to-Home Transitions.
• Transcranial Doppler Ultrasonography (TCD) Screening for Children with Sickle Cell Disease.

Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) Survey

The Child HCAHPS survey asks parents or guardians about the pediatric inpatient experience of care and was developed as a measure for public reporting, quality management, and tracking purposes. Child HCAHPS allows tracking of quality improvement within individual hospitals and comparison of quality across pediatric settings. Results from the Child HCAHPS survey may provide insights for patients, parents, hospitals, health plans, insurers, and policy makers.

This toolkit supplies materials to support hospital and health system users in assessing pediatric inpatient experiences and tracking quality and improvement across settings. The toolkit provides guidance for the administration and measure reporting of Child HCAHPS, with the goal of helping providers and other key stakeholders better understand the needs and experiences of pediatric patients and their families and caregivers. In addition, the toolkit describes work with State programs to ensure the meaningful use of the Child HCAHPS Survey to compare within and across State-level hospitals.

The Center of Excellence for Pediatric Quality Measurement at Boston Children's Hospital created this toolkit. The Child HCAHPS has National Quality Forum endorsement.

Metabolic Monitoring for Children and Adolescents on Antipsychotics

The safe and judicious use of antipsychotic medications in children and adolescents measure set consists of three measures:

• Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics.
• Metabolic Monitoring for Children and Adolescents on Antipsychotics.
• Use of Multiple Concurrent Antipsychotics in Children and Adolescents.

The safe and judicious use of antipsychotic medications is a critical issue for children and youth. While antipsychotic medications may serve as an effective treatment for a defined set of psychiatric disorders in children and adolescents, it is important to follow clinical guidelines for use. Antipsychotic medications can increase the risk of serious health problems, such as metabolic and physical health complications, which can adversely affect development. The measures in this toolkit were designed to encourage responsible prescribing.

The National Collaborative for Innovation in Quality Measures: Implementing and Improving (NCINQ II) created this toolkit. The change ideas, resources, and examples presented in this toolkit reflect efforts by State Medicaid agencies, health plans, and practices to improve performance on the measures. They are intended to serve as options that States, plans, providers, and patients and their families can apply.

Pediatric Asthma Emergency Department Use 

The Pediatric Asthma Emergency Department Use measure estimates the rate of emergency department visits for children and youth ages 3-21 years who are being managed for identifiable asthma, using specified definitions. Asthma affects approximately 1 in 12 children in the United States and is associated with increased hospitalizations and emergency department visits, a significant proportion of which can be avoided with appropriate primary care asthma management.

In addition to providing an overview for the asthma emergency department use measure, this toolkit explains how to develop and implement quality measurement and improvement strategies in primary care settings to reduce asthma-related emergency department visits. Potential end users of the measure include local and State health departments, health plans, health systems, accountable care organizations, improvement partners, provider groups, and primary care practices and clinics.

The IMPLEmenting MEasures NeTwork (IMPLEMENT) for Child Health Network created this toolkit. The pediatric asthma emergency department use measure has National Quality Forum endorsement.

Quality of Pediatric Hospital-to-Home Transitions 

This toolkit seeks to help users improve overall performance on hospital-to-home transitions, by enhancing the quality of the written discharge instructions provided to families and caregivers. Transitions of care can occur in multiple ways and create situations in which the care of a pediatric patient is handed off to a new set of healthcare providers or to home-based family caregivers. An effective transition provides support to decrease the likelihood of  inappropriate care and potential medical complications in the next setting of care.

The Pediatric Hospital Care Improvement Project (P-HIP) developed Transitions of Care Quality Measures to capture the quality of transitions in the inpatient setting, and from the inpatient setting to home. P-HIP selected one of these measures, related to family/caregiver written discharge instructions content, as the focus for this toolkit.

The toolkit includes materials to support providers, hospitals, and medical staff involved in discharge documentation for pediatric patients in improving the quality of medical documentation at discharge, providing additional discharge information for families and caregivers, and monitoring the level and quality of care coordination for transitions between sites.

Transcranial Doppler Ultrasonography (TCD) Screening for Children with Sickle Cell Anemia 

This measure calculates the percentage of children ages 2 through 15 years old with sickle cell anemia who received at least one TCD screening within the measurement year. Children with sickle cell anemia have more than 300 times the stroke risk as children with normal hemoglobin, and TCD screening is a reasonable method to assess stroke risk among children with sickle cell anemia. A higher proportion of TCD screening indicates better performance as reflected by appropriate testing.

The Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium (Q-METRIC) created this toolkit to support use of the TCD screening measure by decision-makers at the State and health plan levels. The measure may be used at the State-level for public reporting, public health/disease surveillance, and quality improvement efforts within the State and among Medicaid and CHIP health plans. Health plans may use the measure for public reporting and quality improvement efforts.

To support implementation of the measure at different levels, the toolkit describes how the Q-METRIC team assessed the ability to fold the measure up and down using aggregated and disaggregated data to specifically address attribution.

The TCD screening for children with sickle cell anemia measure has National Quality Forum endorsement.