CHIPRA Measures by CHIPRA Categories
Initial Core Set and Pediatric Quality Measures Program Centers of Excellence Measure Assignments
The Agency for Healthcare Research and Quality (AHRQ) has made seven awards to Centers of Excellence (CoE) across the United States. Each CoE has a broad coalition of consumer stakeholders, health services researchers, and State agency partners to inform its work. Each CoE will develop or enhance five to six pediatric quality measures and test the performance of those measures against specific criteria identified in the CHIPRA legislation.
A list of the priority topics being addressed by the Centers of Excellence is below.
|CHIPRA Category||Initial Core Set Measurei||PQMP CoE Measure Assignment|
|Duration of enrollment||n/a||Duration of enrollment/continuity of insurance coverage (standalone measure and risk-adjustment measure)ii|
|Availability of services||Children and adolescents' access to primary care practitioners, by age and total||Availability of high-risk obstetric servicesvii|
|Availability of services (other than high-risk obstetric services)viii|
|Family experiences of care||HEDIS CAHPS 4.0 instruments including supplements for children with chronic conditions and Medicaid plans||Inpatient family experiences of care (Pediatric H-CAHPS)vi|
|Youth-reported survey (literacy, confidentiality, risk-taking behaviors)iv|
|Identification of children with special health care needs||n/a||Identification of children with special health care needsiii|
|Continuum of care||n/a||Continuum of carev|
|Transitions/Care coordination||n/a||General medication reconciliationvii,2|
|Quality of transitions from pediatric- to adult-focused carevi|
|Transitions between care settingsiii|
|Identification of social complexity for care coordinationiii|
|Care coordination for children with special health care needs in the context of the medical homeiii|
|Hospital readmissions||n/a||Hospital readmissionsvi|
|Person-reported outcomes||n/a||Person-reported outcomes, including functional assessmentii|
|Quality of care for children in the child welfare system||n/a (specifically to this population, although other measures can be used with this population)||Quality of care for children in the child welfare system, including psychotropic/antipsychotic use and care coordination for socially complex children3; others to be identifiediv|
|Quality to cost||n/a||Quality to cost measureii|
|Specific Clinical Categories|
|Prevention and health promotion|
|Frequency of ongoing prenatal care||Content of prenatal carev|
|Timeliness of prenatal care—the percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester or within 42 days of enrollment in the organization|
|Percent of live births weighing less than 2,500 grams|
|Cesarean rate for nulliparous singleton vertex||n/a|
|Childhood immunization status (by 2nd birthday)||n/a|
|Immunizations for adolescents (by 13th birthday)|
|Weight assessment for children/adolescents||BMI followup and treatmentviii|
|Use of standardized screening tools for potential delays in social and emotional development||Developmental screening and followupv,4|
|Chlamydia screening for women ages 16-20||Adolescent depression screening, diagnosis, treatment, followupiv|
|Alcohol and substance use screening, diagnosis, treatment, followupiv|
|WCVs in the first 15 months of life||Content of well-child care visitsiv|
|WCVs in the 3rd, 4th, 5th, and 6th years of life|
|WCVs for 12-21 years of age—with PCP or Ob-gyn||Content of well-adolescent care visitsiv|
|Total eligibles receiving preventive dental services (EPSDT measure Line 12B)||n/a|
|Management of acute conditions|
|Pharyngitis—appropriate testing related to antibiotic dispensing||n/a|
|Otitis Media with Effusion—avoidance of inappropriate use of systemic antimicrobials—ages 2-12||Otitis Media with Effusion—avoidance of inappropriate use of systemic antimicrobials—ages 2-12ii,4|
|Total EPSDT eligibles who received dental treatment services (EPSDT CMS Form 416, Line 12C)||Dental treatment servicesv,4|
|Emergency Department Utilization—Average number of ED visits per member per reporting period.||n/a; except see above re asthma ED measure|
|Pediatric catheter-associated blood stream infection (CLABSI)� rates (PICU and NICU)||Global patient safety tool measurevi|
|Temperature on admission to NICUvii|
|Pediatric intensive care unit (TBI)v|
|n/a||Imaging for seizures and headacheviii|
|Management of Chronic Conditions6|
|Annual number of asthma patients (≥1 year old) with ≥ one asthma related emergency department visit||Asthma ED visitvii,4|
|Respiratory bundle (asthma and bronchitis)viii|
|Followup care for children prescribed ADHD medication (continuation and maintenance phase)||Followup care for children with ADHD (diagnosis, treatment, management)v|
|Followup after hospitalization for mental illness||Followup after mental hospitalizationvii|
|Medication reconciliation—mental healthvii|
|Mental health hospital admissionsiii|
|Mental health hospital qualityiii|
|Mental health ED admissionsiii|
|Mental health ED qualityiii|
|Annual hemoglobin A1C testing (all children and adolescents diagnosed with diabetes)|
|n/a||Sickle cell treatmentviii|
|n/a||Access to disability support servicesvi|
CAHPS® = Consumer Assessment of Health Providers and Systems.
CHIPRA = Children's Health Insurance Reauthorization Act.
COE = Center(s) of Excellence (PQMP.)
HEDIS = Health Employer Data Information System (NCQA).
n/a = Not applicable.
NCQA = National Committee for Quality Assurance.
PQMP = Pediatric Quality Measures Program (CHIPRA).
1. For information on the COEs (Centers of Excellence), visit http://www.ahrq.gov/chipra/pqmpfact.htm.
2. Also see mental health.
3. Also see Care coordination for socially complex children. NCINQ will build on the measure being developed by COE4CCN to make it applicable for children in the child welfare system.
4. In cases where a measure topic assigned to the PQMP COEs is similar to an initial core measure, the measure assignment is to improve on the initial core measure.
5. Can also apply to chronic conditions.
6. Also see under screening mention of diagnosis, treatment and followup.
7. Also see screening under prevention and health promotion.
i. For details, see http://www.ahrq.gov/chipra/corebackground/corebacktab.htm; Initial Core Set of Children’s Health Care Quality Measures:
Technical Specifications and Resource Manual for Federal Fiscal Year 2011 Reporting. For reports on States' voluntary reporting of the initial core set, visit http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/CHIPRA-Initial-Core-Set-of-Childrens-Health-Care-Quality-Measures.html.