1. The CHIPRA Pediatric Quality Measures Program: Health Information Technology and Patient Safety Edwin Lomotan, MD, FAAP Office of Extramural Research, Education, and Priority Populations AHRQ Annual Conference September 10, 2012

2. Learning Objectives Identify the patient safety measures being developed by the Centers of Excellence 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 Describe challenges to developing pediatric quality measures designed for implementation within electronic health records

3. CHIPRA Children’s Health Insurance Program Reauthorization Act of 2009 Children’s Health Insurance Program Reauthorization Act of 2009 Title IV – Strengthening Quality of Care and Health Outcomes 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 Initial core set of measures – Section 401 (b) – Advancing and Improving Pediatric Quality Measures Creation of the Pediatric Quality Measures Program Creation of the Pediatric Quality Measures Program

4. CHIPRA – Initial Core Set Identified by AHRQ National Advisory Council Subcommittee on Children's Healthcare Quality Measures for Medicaid and CHIP Identified by AHRQ National Advisory Council Subcommittee on Children's Healthcare Quality Measures for Medicaid and CHIP Required consideration of existing measures Required consideration of existing measures 24 recommended measures covering a wide range of topics and ages 24 recommended measures covering a wide range of topics and ages Released December 2009 Released December 2009

5. Initial Core Set: Summary Prevention and health promotion Prevention and health promotion – Prenatal/perinatal (4) – Immunizations (2) – Screening (3) – Well child care visits (3) – Dental (1) Management of acute conditions 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 Management of chronic conditions – Asthma (1) – ADHD (1) – Mental health (1) – Diabetes (1) Family experiences of care Family experiences of care – CAHPS, child version (1) Availability Availability – Children and adolescent access to PCPs (1)

6. Pediatric Quality Measures Program (PQMP) Purpose Purpose – To identify new recommended core sets annually beginning January 1, 2013 – To fill gaps left by the initial core set Core measure requirements 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

7. PQMP – Components 7 Centers of Excellence 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) 2 CMS Quality Demonstration Grantee States (IL, MA) Coordinating and Technical Assistance Center contract (RTI) Coordinating and Technical Assistance Center contract (RTI) AHRQ-CMS collaboration AHRQ-CMS collaboration Public input Public input 4 year program beginning March 2011 4 year program beginning March 2011

8. 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 1 st ) Subcommittee to AHRQ’s National Advisory Council (SNAC)

9. Patient Safety Measure Assignments Global patient safety tool Global patient safety tool Imaging for seizures and headache Imaging for seizures and headache Medication reconciliation Medication reconciliation Psychotropic medication use Psychotropic medication use Alcohol and substance use screening, diagnosis, treatment, and follow up Alcohol and substance use screening, diagnosis, treatment, and follow up Temperature on admission to NICU Temperature on admission to NICU Pediatric Intensive Care Pediatric Intensive Care

10. Health IT: CHIPRA and Meaningful Use 5 measures appear in both Meaningful Use and in the CHIPRA initial core set 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

11. PQMP Informatics Presentation by NQF on the Quality Data Model at kick-off meeting Presentation by NQF on the Quality Data Model at kick-off meeting Informatics Workgroup Informatics Workgroup – Co-chaired by Marjorie Rallins (AMA-PCPI) and Aldo Tinoco (NCQA) Working with ONC and CMS Working with ONC and CMS – Measures for potential use in future stages of Meaningful use

12. Moving the PQMP and Health IT Forward Sample challenges 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

13. Resources AHRQ CHIPRA AHRQ CHIPRA – http://www.ahrq.gov/chipra/ http://www.ahrq.gov/chipra/ CHIPRA Initial Core Set and Centers of Excellence Measure assignments CHIPRA Initial Core Set and Centers of Excellence Measure assignments – http://www.ahrq.gov/chipra/pqmpmeasures.htm http://www.ahrq.gov/chipra/pqmpmeasures.htm CMS CHIPRA CMS CHIPRA – http://www.medicaid.gov/Medicaid-CHIP-Program- Information/By-Topics/Childrens-Health-Insurance-Program- CHIP/CHIPRA.html http://www.medicaid.gov/Medicaid-CHIP-Program- Information/By-Topics/Childrens-Health-Insurance-Program- CHIP/CHIPRA.html http://www.medicaid.gov/Medicaid-CHIP-Program- Information/By-Topics/Childrens-Health-Insurance-Program- CHIP/CHIPRA.html – http://www.insurekidsnow.gov/ http://www.insurekidsnow.gov/ Model children’s EHR format Model children’s EHR format – http://www.ahrq.gov/chipra/ehrformatfaq.htm http://www.ahrq.gov/chipra/ehrformatfaq.htm

14. Questions? Questions? – edwin.lomotan@ahrq.hhs.gov edwin.lomotan@ahrq.hhs.gov 2012 SNAC Meeting 2012 SNAC Meeting – Wednesday, September 12, 2012 – Bethesda Marriott Hotel, 5151 Pooks Hill Road, Bethesda, Maryland 20814 – Begins at 7:45 am