Courtney Gidengil1, Rita Mangione-Smith2, L Charles Bailey3, Mary Lawrence Cawthon4, Elizabeth A McGlynn5, Mari M Nakamura6, Jeffrey Schiff7, Mark A Schuster8, Eric C Schneider9. 1. RAND Corporation, Boston, Mass; Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: gidengil@rand.org. 2. Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Wash; Seattle Children's Research Institute, Seattle, Wash. 3. Children's Hospital of Philadelphia, Philadelphia, Pa. 4. Research and Data Analysis Division, Washington Department of Social and Health Services, Olympia, Wash. 5. Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, Calif. 6. Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Division of General Pediatrics, Boston Children's Hospital, Boston, Mass. 7. Office of the Medicaid Medical Director, Minnesota Department of Human Services, St Paul, Minn. 8. Harvard Medical School, Boston, Mass; Division of General Pediatrics, Boston Children's Hospital, Boston, Mass. 9. RAND Corporation, Boston, Mass; Harvard Medical School, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
Abstract
OBJECTIVE: We sought to explore the claims data-related issues relevant to quality measure development for Medicaid and the Children's Health Insurance Program (CHIP), illustrating the challenges encountered and solutions developed around 3 distinct performance measure topics: care coordination for children with complex needs, quality of care for high-prevalence conditions, and hospital readmissions. METHODS: Each of 3 centers of excellence presents an example that illustrates the challenges of using claims data for quality measurement. RESULTS: Our Centers of Excellence in pediatric quality measurement used innovative methods to develop algorithms that use Medicaid claims data to identify children with complex needs; overcome some shortcomings of existing data for measuring quality of care for common conditions such as otitis media; and identify readmissions after hospitalizations for lower respiratory infections. CONCLUSIONS: Our experience constructing quality measure specifications using claims data suggests that it will be challenging to measure key quality of care constructs for Medicaid-insured children at a national level in a timely and consistent way. Without better data to underpin pediatric quality measurement, Medicaid and CHIP will have difficulty using some existing measures for accountability, value-based purchasing, and quality improvement both across states and within states.
OBJECTIVE: We sought to explore the claims data-related issues relevant to quality measure development for Medicaid and the Children's Health Insurance Program (CHIP), illustrating the challenges encountered and solutions developed around 3 distinct performance measure topics: care coordination for children with complex needs, quality of care for high-prevalence conditions, and hospital readmissions. METHODS: Each of 3 centers of excellence presents an example that illustrates the challenges of using claims data for quality measurement. RESULTS: Our Centers of Excellence in pediatric quality measurement used innovative methods to develop algorithms that use Medicaid claims data to identify children with complex needs; overcome some shortcomings of existing data for measuring quality of care for common conditions such as otitis media; and identify readmissions after hospitalizations for lower respiratory infections. CONCLUSIONS: Our experience constructing quality measure specifications using claims data suggests that it will be challenging to measure key quality of care constructs for Medicaid-insured children at a national level in a timely and consistent way. Without better data to underpin pediatric quality measurement, Medicaid and CHIP will have difficulty using some existing measures for accountability, value-based purchasing, and quality improvement both across states and within states.
Authors: Regie Lyn P Santos-Cortez; Ma Rina T Reyes-Quintos; Ma Leah C Tantoco; Izoduwa Abbe; Erasmo Gonzalo D V Llanes; Nadim J Ajami; Diane S Hutchinson; Joseph F Petrosino; Carmencita D Padilla; Romeo L Villarta; Teresa Luisa Gloria-Cruz; Abner L Chan; Eva Maria Cutiongco-de la Paz; Charlotte M Chiong; Suzanne M Leal; Generoso T Abes Journal: Otolaryngol Head Neck Surg Date: 2016-08-02 Impact factor: 3.497
Authors: Mari M Nakamura; Sara L Toomey; Alan M Zaslavsky; Carter R Petty; Chen Lin; Guergana K Savova; Sherri Rose; Mark S Brittan; Jody L Lin; Maria C Bryant; Sepideh Ashrafzadeh; Mark A Schuster Journal: Acad Pediatr Date: 2018-11-20 Impact factor: 3.107