SNAC-recommended Initial Core Set, September 18, 2009
Title IV of the Children's Health Insurance Program Reauthorization Act (CHIPRA; Public Law 111-3) required the Secretary of the U.S. Department of Health and Human Services (HHS) to identify and post for public comment by January 1, 2010, an initial, recommended core set of children's health care quality measures for voluntary use by Medicaid and Children's Health Insurance Programs (CHIP), health insurance issuers and managed care entities that enter into contracts with such programs, and providers of items and services under such programs.
This report presents a brief summary of the processes used to identify an initial core set of children's healthcare quality measures for recommendation to the AHRQ National Advisory Council on Healthcare Research and Quality, the measures recommended, and next steps to be taken by AHRQ and CMS. Table 1 summarizes the recommended core measure set.
The initial core measure set includes one or more measures for almost all of the health care topics and criteria specified in the legislation. Quality measures are recommended for services to prevent disease and promote health, and to treat and manage a spectrum of acute and chronic conditions experienced by children, including physical, mental, and dental disorders. The measure set includes measures designed to assess family experiences of care and availability of services. Measures address services provided across the age continuum and in both the outpatient and inpatient settings. All but four of the measures are supported by evidence for a relatively high level of validity. The validity ratings for the others are supported by substantial professional consensus.
There were, however, a number of legislative topics for which currently available, valid, and feasible measures could not be identified, and some legislative criteria that could not be met. These include measures of the "most integrated health care delivery settings," more valid measures of availability of services, and importantly, a core measure of duration of enrollment and coverage for use in quality reporting and surveillance. In addition, neither the recommended measure set as currently specified, nor the body of measures in use by Medicaid, CHIP and others, currently meet the CHIPRA goals of identifying disparities by race and special health care needs status or measuring and improving quality across all enrollees in Medicaid and CHIP programs. Thus, additional work is needed to develop measures and specifications to meet these challenges, and to provide technical assistance to the Medicaid and CHIP programs and the plans and providers on whom they rely to deliver high quality care.