Group to identify quality measures for kids
Group to identify quality measures for kids
FACCT, NCQA join forces
The field of pediatrics has long recognized that children aren’t just pint-sized adults. But the field of health care quality measurement has not, for the most part, until now. A joint effort that began last spring between The Foundation for Accountability (FACCT) and the National Com mittee for Quality Assurance (NCQA) plans to change that by developing a core set of quality measures for children’s health care.
The effort, known as the Children’s Health Measurement Initiative, will enable consumers, purchasers, and providers to evaluate and improve the quality performance of health plans, physicians, children’s hospitals, and anyone else involved in pediatric care. Over the next two years, the CHMI advisory committee — made up of children’s health clinicians, researchers, consumer representatives, purchasers, providers, and health plans — will ensure the measures and tools created are relevant to consumers and based on the best scientific and clinical evidence available in children’s health care.
"Current measures are limited in regards to children," says Christina Bethell, PhD, MPH, MBA, director of accountability measurement for Portland, OR-based FACCT. "There are some measures for things like immunizations, but there are few for chronic conditions, preventive care, or acute care. There isn’t much patient-based information to help us see if children’s needs are being met. It’s not appropriate to use measures for adults as a proxy for children."
The proposed measures will cut across all facets of children’s care, but the first priorities will be in areas where the greatest measurement gaps exist: adolescent risk reduction, promoting healthy development of small children, and care for children with chronic illnesses, Bethell says. Three groups will identify measures in those areas: "the basics/staying healthy," "getting better," and "living with illness/changing needs." A fourth will review measures from all task forces and recommend a subset of measures for inclusion in NCQA’s Health Employer Data and Information Set (HEDIS).
Because children are in a developmental stage, outcomes may take years to materialize and can be hard to specify and measure, she says. A child’s development curve can affect outcomes, and that’s something for which it can be hard to adjust. Also, parents and the child’s environments are key to a child’s health. Since children must depend on their parents for access to health care and parents are often required to report on behalf of their children for quality measurement purposes, the results can be skewed. In short, any challenges in measurements for adults are amplified for children.
"Finding sufficient numbers of children in a health plan or medical group to create stable performance statistics is challenging," Bethell says. "Because of this, composite scores that combine information across groups of children are often necessary. Another issue is that while significant consensus already exists about standards of care and desired outcomes of care for children, very little randomized, controlled trial-level science exists for children’s health care process and outcomes measures. To move forward, the measures review teams will have to rely on other levels of evidence, including expert consensus."
The consensus-building also will involve consumers, Bethell says. The task forces hold focus groups with parents and adolescents to find out how they define quality and what types of quality information they’re interested in. As they proceed with the design of, for example, a family survey, cognitive interviews are done with families.
"We talk to whoever is expected to fill out the survey because these surveys are the best and sometimes only way to get certain types of outcome and experience of care information for kids," she explains. "Here we learn about the relevance of the measures generated from the survey, the wording of the questions and their response sets, the layout of the survey, how best to administer the survey to encourage a good response rate, and so on."
Consumer organizations and individuals have been invited to attend national meetings of the group, and another round of focus groups will be done at the end of the process to make sure the information is relevant to consumers, Bethel says. CHMI wants to follow this process involving key stakeholders so the resulting measures will be useful and credible enough to be widely adopted.
Of course, with the backing and full participation of NCQA and inclusion in HEDIS, the proposed measures likely will become standard. "Pediatrics has been one of the recognized gap areas in HEDIS for some time," says NCQA spokesman Brian Schilling. "We’re have a robust initiative in place to develop and refine HEDIS measures, and this area is a priority."
HEDIS includes utilization measures relating to childhood and adolescent immunizations, prenatal care, and well-child visits, but none that get to the heart of the experience and outcomes of pediatric care. The task forces will develop these types of measures as well as documents showing how to use the measures for quality improvement purposes.
"Our hope is that providers will see the benefits of having quality information that cuts across the five categories and three types of measures — process, outcome, and patient experience of care — that we are focusing on," Bethell says.
[For more information on the Children’s Health Measurement Advisory Committee, contact FACCT at 520 SW Sixth Ave., Suite 700, Portland, OR 97204. Telephone: (503) 223-2228.]
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