G


Administrative Data

NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) MEDICAID HEALTHCARE EFFECTIVENESS DATA AND INFORMATION SET (HEDIS®) BENCHMARKING

Current Established Child Measures in a Data System That Supports Benchmarking: 23 HEDIS measures: effectiveness of care (childhood immunization status, adolescent immunization status, chlamydia screening for women, and use of appropriate medications for people with asthma); accessibility/availability of care (children’s access to primary care practitioners, annual dental visit), and experience of care (Consumer Assessment of Healthcare Providers and Systems [CAHPS®] 3.0H Child Survey [including screener for children with chronic conditions and composite measures]).

Current Established Child Measures: n/a

Current Other Measurement Activities Using Various Child Measures, Including Established Measures and Indicators: n/a

Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a

Other Activities Producing Data That Could Potentially Be Used for Measurement: n/a

Age: Measure-specific



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 289
G Administrative Data NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) MEDICAID HEALTHCARE EFFECTIVENESS DATA AND INFORMATION SET (HEDIS®) BENCHMARKING Current Established Child Measures in a Data System That Supports Benchmarking: 23 HEDIS measures: effectiveness of care (childhood im- munization status, adolescent immunization status, chlamydia screening for women, and use of appropriate medications for people with asthma); accessibility/availability of care (children’s access to primary care practitioners, annual dental visit), and experience of care (Consumer Assessment of Health- care Providers and Systems [CAHPS®] 3.0H Child Survey [including screener for children with chronic conditions and composite measures]). Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: n/a Age: Measure-specific 289

OCR for page 289
290 CHILD AND ADOLESCENT HEALTH Frequency: Annually—calendar year (continuous enrollment defined differ- ently for Medicaid than for commercial plans) Race/Ethnicity: Not reported Unit Level: Hospital, Physician, Clinic, Managed Care Organization (MCO), State: MCO Geography: Most state (state-specific) Medicaid programs use HEDIS or HEDIS-like specifications (HEDIS specifications but not “continuous enrollment”) Use: Improvement/Accountability: Improvement and accountability Goal: Safety/Well-Being/Permanency: Well-being Data Source: Administrative data, medical records, or, for the CAHPS® Limitations: n/a MEDICARE HOSPITAL COMPARE Current Established Child Measures in a Data System That Supports Bench- marking: Medicare Compare: includes children’s asthma process-of-care measures; however, the numbers are often too small for reliability and/or public reporting. Three asthma measures: % children who received reliever medication while hospitalized for asthma, % children received systemic corticosteroid medication while hospitalized for asthma, and % children and caregivers who received a home management plan of care. Children’s hospitals are included in the reports, as well as acute care hospitals. Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: n/a Age: Measure-specific

OCR for page 289
291 APPENDIX G Frequency: Annually Race/Ethnicity: Not reported Unit Level: Hospital, Physician, Clinic, MCO, State: Provider Geography: All hospitals within states reporting on Medicare Compare, but for some measures the numerator/denominator is n/a because of small size Use: Improvement/Accountability: Improvement and accountability Goal: Safety/Well-Being/Permanency: Safety and well-being Data Source: Hospital reporting based on Centers for Medicare and Med- icaid Services (CMS) specifications. Date—sample of cases. Limitations: n/a HEDIS FOR MEDICAID/CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: Effectiveness of care (childhood im- munization status, adolescent immunization status, chlamydia screening for women, and use of appropriate medications for people with asthma); accessibility/availability of care (children’s access to primary care practi- tioners, annual dental visit), and experience of care (CAHPS 3.0H Child Survey [including screener for children with chronic conditions and com- posite measures]). Arkansas CHIP MCOs and California and Washington, DC, Medicaid MCOs submit audited HEDIS and CAHPS data. California requires CHIP MCOs to be audited. Colorado must submit disenrollment HEDIS measures. Florida MCOs submit member data for indicators of access or quality of care. Massachusetts, New Jersey, New York, Utah and Maryland MCOs report HEDIS data annually to the state. Minnesota, New Mexico, Pennsylvania, Rhode Island, and Montano require audited HEDIS data. Ohio requires selected audited HEDIS and HEDIS-like measures, Ten- nessee MCOs required to report HEDIS in conjunction with their NCQA accreditation, and Nebraska requires the most recent HEDIS encounter data.

OCR for page 289
292 CHILD AND ADOLESCENT HEALTH Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially be Used for Mea- surement: n/a Age: Measure-specific Frequency: Annually—calendar year (continuous enrollment defined differ- ently for Medicaid than for commercial plans) Race/Ethnicity: Not reported Unit Level: Hospital, Physician, Clinic, MCO, State: Most states Medicaid MCOs, many states CHIP stand-alone, several states Primary Care Case Management (PCCM): North Carolina, Massachusetts, Colorado Geography: Significant subset of states but not all states Use: Improvement/Accountability: Improvement and accountability Goal: Safety/Well-Being/Permanency: Well-being Data Source: Administrative data/claims data (MCOs and PCCMs), medi- cal records (MCOs), or, for the Consumer Assessment of Health Plans (CAHPS). Limitations: n/a CONSUMER ASSESSMENT OF HEALTH PLANS (CAHPS) Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: MCOs, behavioral health overlays (BHOs), dental plans, medical groups, physician offices, and clinics. Same for Medicaid and commercial. Supplemental questions related to child care, chronic conditions, claims processing, communication, coverage by mul- tiple plans, dental care, interpreter, Medicaid enrollment, personal doctor,

OCR for page 289
293 APPENDIX G quality improvement, access to routine care, access to specialist care, after hours care, calls to personal doctor’s office, coordination of care from other health providers, customer service, health plan information and materials, referrals, specialist services, transportation, utilization, and wellness. Two supplemental surveys are in process of development: health information technology (HIT) and cultural competency. Users of survey results have ac- cess to reporting measures as well as guidelines that reflect “best practices” in reporting. Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: n/a Age: Adults aged 18 and older and children aged 17 and younger. Patient completes the adult questionnaire, while patient’s parent or guardian com- pletes the child questionnaire. Frequency: Annually Race/Ethnicity: Can be identified not traditionally reported Unit Level: Hospital, Physician, Clinic, MCO, State: Depending on survey: provider, MCO, or state Geography: Significant subset of states but not all states Use: Improvement/Accountability: Improvement and accountability Goal: Safety/Well-Being/Permanency: Safety and well-being Data Source: Standardized survey tool, but modules vary. CAHPS uses standardized content, format, protocol for fielding, set of analysis programs and instructions, and approach to presenting survey results. Limitations: n/a

OCR for page 289
294 CHILD AND ADOLESCENT HEALTH CHILD AND ADOLESCENT HEALTH MANAGEMENT INITIATIVE (CAHMI) Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: Ambulatory care-sensitive hospital- ization measures, medical home for children with special heath care needs (CSHCN), and mental and behavioral quality measures for children and adolescents. Promoting Healthy Development Survey (PHDS) parent survey assessing whether young children (3–48 months old) are receiving nation- ally recommended preventive and developmental services. CSHCN module is a set of survey-based methods and tools designed to identify children with special health care needs and measure the basic aspects of health care quality. CAHMI Young Adult Health Care Survey (YAHCS) measures the quality of preventive health care provided to adolescents: preventive screen- ing and counseling on risky behaviors, sexual activity and sexually trans- mitted diseases (STDs), weight, healthy diet and exercise, and emotional health and relationship issues; private and confidential care; helpfulness of counseling; communication and experience of care (derived from draft Adolescent CAHPS); health information; and global quality measure (teens received all the components of care measures). Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: n/a Age: Measure-specific Frequency: Measure-specific: administered by mail, telephone, online, and in pediatric offices Race/Ethnicity: Ability to collect Unit Level: Hospital, Physician, Clinic, MCO, State: Measure-specific: provider, system, and state

OCR for page 289
295 APPENDIX G Geography: To date, more than 45,000 surveys have been collected by 10 Medicaid agencies, four MCOs, 38 pediatric practices, and nationally through the National Survey of Early Childhood Health (NSECH). Use: Improvement/Accountability: Improvement and accountability Goal: Safety/Well-Being/Permanency: Safety and well-being Data Source: Set of survey-based methods and tools—English and Spanish Limitations: n/a MEDICAL HOMES PRACTICE MEASURES Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: Aspects of care measured by Physician Practice Connections®-Patient-Centered Medical Home™ (PPC-PCMH): access and communication, patient tracking and registry functions, care management, patient self-management support, e-prescribing, test and re- ferral tracking, performance reporting and improvement, and advanced electronic communications. Medical Home Index (MHI): validated self- assessment and classification tool designed to rank the level (1–4) of the practice in six domains (organizational capacity, chronic condition man- agement, care coordination, community outreach, data management, and quality improvement and change. Medical Home Family Index (MHFI): companion survey to be completed by families whose children receive care from a practice by whom their child has been seen for more than a year. NCQA has established Physician PPC-PCMH practice measures of perfor- mance that measure clinical process, clinical outcomes, service data, and patient safety. For the clinical process and outcome measures, NCQA Dia- betes Physician Recognition Program (DPRP) or Heart Stroke Recognition Program (HSRP) measures are used, but the HSRP is not a child measure. Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: n/a

OCR for page 289
296 CHILD AND ADOLESCENT HEALTH Age: Measure-specific Frequency: Annually—calendar year for HEDIS; year experience for other Race/Ethnicity: Measure-specific for collection—unknown reporting Unit Level: Hospital, Physician, Clinic, MCO, State: Provider Geography: Not necessarily statewide as provider-specific and voluntary. Pennsylvania Medical Home Project (EPIC IC) has adapted the MHI into a two-page questionnaire. Use: Improvement/Accountability: Improvement and accountability Goal: Safety/Well-Being/Permanency: Safety and well-being Data Source: Practices seeking PPC-PCMH complete a Web-based data col- lection tool and provide documentation that validates responses Limitations: n/a NATIONAL QUALITY FORUM (NQF) Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: Current pediatric measures: attention- deficit/hyperactivity disorder (ADHD) diagnosis, management and medi- cation follow-up; all-cause readmission index; pharyngitis testing; upper respiratory infection (URI) treatment; asthma assessment, management, and pharmacologic therapy; body mass index (BMI); CAHPS; central line catheter infection rate for intensive care unit (ICU) and high-risk nursery (HRN); immunizations; chlamydia screening; patient fall rate; falls with injury; hemoglobin A1c; home management plan of care; iatrogenic pneu- mothorax in non-neonates; tobacco prevention or cessation; serum calcium and phosphorus concentration; neonate immunization; newborn care (NC) hours/patient day; pediatric heart surgery mortality and volume; pediatric patient safety and weight; pediatric intensive care unit (PICU) pain assess- ment on admission, periodic pain assessment, length of stay (LOS), mortal- ity ratio, unplanned readmission rate, and Pediatric Quality Indicator (PDI) 11; Promoting Healthy Development Survey (PHDS); ICU in the last 30 days of life; infants screened for retinopathy; skill mix, unlicensed assistive personnel (UAP); transfusion reaction; ventilator-associated pneumonia for

OCR for page 289
297 APPENDIX G ICU and HRN; YAHCS. NQF has measures in progress related to ADHD, asthma, and management of labor. Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: n/a Age: NQF has numerous quality measures but limited number of pediatric- specific measures, and the measures that address children are sometimes included in the numerator and denominator or a larger population; when they are separated, they are not separated by consistent age breaks as NQF is guided by evidence-based medicine. Frequency: Annually Race/Ethnicity: Sometimes collected but may not be reported Unit Level: Hospital, Physician, Clinic, MCO, State: Dependent on measure Geography: Dependent on measure Use: Improvement/Accountability: Improvement and accountability Goal: Safety/Well-Being/Permanency: Safety and well-being Data Source: Dependent on measure Limitations: n/a PHYSICIAN QUALITY REPORTING INITIATIVE (PQRI) Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: Of the 175 individual quality mea- sures and 4 measures in back pain selected for adult PQRI quality measures, there are a significant number of measures for children or for which chil- dren are included in the denominator. PQRI measure specifications: title,

OCR for page 289
298 CHILD AND ADOLESCENT HEALTH reporting option (claims or registry), description, frequency, time frames and applicability, numerator and denominator coding, definitions of terms, coding instructions, use of Current Procedural Terminology (CPT) Category II exclusion modifiers and rationale. Specific measures: multiple related to perioperative care; aspirin for acute myocardial infarction (AMI), multiple asthma, treatment for URI, appropriate testing for children with pharyngi- tis, prevention of catheter-related bloodstream infection (CRBSI), multiple acute otitis externa (AOE), otitis media with effusion (OME) diagnosis evaluation, breast cancer resection pathology reporting, colorectal cancer resection, HIT, e-prescribing, melanoma follow-up and coordination of care, multiple oncology, radiology exposure, dose limits and inappropri- ate use of “probably benign,” correlation with bone scintigraphy imaging, multiple HIV, 2 pediatric end stage renal disease (ESRD), 3 referral to otologic, cancer stage documented, and multiple functional communication measures. Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: n/a Age: Measure-specific: some all populations and some children-specific Frequency: Annually—calendar year Race/Ethnicity: Unknown Unit Level: Hospital, Physician, Clinic, MCO, State: Provider Geography: National: providers directly to CMS Use: Improvement/Accountability: Accountability Goal: Safety/Well-Being/Permanency: Well-being Data Source: Report information to CMS via a claims-based reporting mechanism (Medicare Part B claims), a registry-based reporting mechanism (qualified PQRI registry), or a qualified electronic health record submission. The specifications for the measures provide details for the numerator and

OCR for page 289
299 APPENDIX G denominator. The denominator population is defined by certain Interna- tional Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis, CPT Category I, and Healthcare Common Pro- cedure Coding System (HCPCS) codes specified in the measure that are submitted by individual eligible professionals (EPs) as part of a claim for covered services under the physician fee schedule (PFS). Limitations: n/a QUALITY IMPROVEMENT SYSTEM FOR MANAGED CARE (QISMC) Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, Including Established Measures and Indicators: 23 HEDIS measures: effec- tiveness of care (childhood immunization status, adolescent immunization status, chlamydia screening for women, and use of appropriate medications for people with asthma); accessibility/availability of care (children’s access to primary care practitioners, annual dental visit), and experience of care (CAHPS® 3.0H Child Survey [including screener for children with chronic conditions and composite measures]). Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: n/a Age: Measure-specific Frequency: Annually—calendar year (continuous enrollment defined differ- ently for Medicaid than for commercial plans) Race/Ethnicity: State determined: quality improvement (QI) projects in- clude breakout by race/ethnicity/special needs Unit Level: Hospital, Physician, Clinic, MCO, State: MCO Geography: States that contract with MCOs for Medicaid

OCR for page 289
316 CHILD AND ADOLESCENT HEALTH Frequency: Ongoing Race/Ethnicity: Unknown Unit Level: Hospital, Physician, Clinic, MCO, State: n/a Geography: 10% of the U.S. population Use: Improvement/Accountability: n/a Goal: Safety/Well-Being/Permanency: n/a Data Source: Combined data from the insurance industry and a public health surveillance system called the immunization information system (IIS) Limitations: Covered population only DEPARTMENT OF VETERANS AFFAIRS (VA) Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: VA and U.S. Food and Drug Administration (FDA) effort to gather and analyze data to gain insight into the effects of the pandemic vaccine in a primarily elderly, inpatient population. As with other active surveillance systems, the data generated by this system will be used to detect the incidence of predefined adverse events of interest. Age: n/a Frequency: Unknown Race/Ethnicity: Unknown

OCR for page 289
317 APPENDIX G Unit Level: Hospital, Physician, Clinic, MCO, State: n/a Geography: Approximately 1 million VA patients Use: Improvement/Accountability: n/a Goal: Safety/Well-Being/Permanency: n/a Data Source: Data from the VA health care system have been used in the past to study incidence rates of adverse events from medications and are well suited to the task of signal strengthening. Limitations: Limited to VA population REAL TIME IMMUNIZATION MONITORING SYSTEM (RTIMS) Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: Automated, Internet-based, passive surveillance system devel- oped at The Johns Hopkins University to complement the Vaccine Adverse Event Reporting System (VAERS). This system specifically monitors post- vaccination outcomes among three of the vaccine priority groups: pregnant women, health care workers, and school children. Age: n/a Frequency: Data entered by vaccines at 1 day, 1 week, and 6 weeks postim- munization to determine rates of adverse events, which will then be re- ported to the VAERS. Race/Ethnicity: Unknown Unit Level: Hospital, Physician, Clinic, MCO, State: n/a

OCR for page 289
318 CHILD AND ADOLESCENT HEALTH Geography: Unknown Use: Improvement/Accountability: n/a Goal: Safety/Well-Being/Permanency: n/a Data Source: n/a Limitations: Populations limited to pregnant women, health care workers, and school children CLINICAL IMMUNIZATION SAFETY ASSESSMENT (CISA) NETWORK Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: Six academic medical centers (The Johns Hopkins University, Boston University, Stanford University, Vanderbilt University, Columbia University, and Northern California Kaiser Permanente), which as an as- sociation often collaborate with CDC in efforts to follow-up on serious VAERS reports, maintain a repository of their findings. Age: n/a Frequency: n/a Race/Ethnicity: Unknown Unit Level: Hospital, Physician, Clinic, MCO, State: n/a Geography: Site-specific with CDC Use: Improvement/Accountability: n/a

OCR for page 289
319 APPENDIX G Goal: Safety/Well-Being/Permanency: n/a Data Source: VAERS reports Limitations: Six academic medical centers VACCINES AND MEDICATIONS IN PREGNANCY SURVEILLANCE SYSTEM (VAMPSS) Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: Collaborative effort between the Organization of Teratology Information Specialists (OTIS), the Slone Epidemiology Center (SEC) at Boston University, and the American Academy of Allergy, Asthma, and Im- munology (AAAAI) to collect data on the health effects of pandemic vaccine administration on maternal and fetal health through case-control studies. Age: n/a Frequency: Case study Race/Ethnicity: Unknown Unit Level: Hospital, Physician, Clinic, MCO, State: n/a Geography: Case study site-specific Use: Improvement/Accountability: n/a Goal: Safety/Well-Being/Permanency: n/a Data Source: Data on the health effects of pandemic vaccine administration on maternal and fetal health through case-control studies

OCR for page 289
320 CHILD AND ADOLESCENT HEALTH Limitations: This system is probably not a source of data that are imme- diately actionable because of the time lag inherent in following groups of vaccinated and unvaccinated women through their pregnancies. AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ) PATIENT SAFETY INDICATORS (PSI) Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: 20 hospital: anesthesia complications, diagnosis-related group (DRG) deaths, decubitus ulcer, failure to rescue, foreign body, iatrogenic pneumothorax, selected infections, multiple postoperative, accidental punc- ture and laceration, transfusion reaction, birth trauma, and three obstetric trauma. Seven area-level PSIs: foreign body left, iatrogenic pneumothorax, selected infections, two postoperative, accidental puncture and laceration, and transfusion reaction. Age: Measure-specific Frequency: Unknown Race/Ethnicity: Not provided Unit Level: Hospital, Physician, Clinic, MCO, State: Hospital and regional Geography: Unknown Use: Improvement/Accountability: Unknown Goal: Safety/Well-Being/Permanency: Safety Data Source: Hospital administrative data using AHRQ software tool Limitations: Voluntary

OCR for page 289
321 APPENDIX G HHS UNIVERSAL CLAIMS DATABASE FOR HEALTH RESEARCH Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: Proposed: all-payer, all-claims database Age: n/a Frequency: To be determined Race/Ethnicity: Unknown Unit Level: Hospital, Physician, Clinic, MCO, State: n/a Geography: To be determined Use: Improvement/Accountability: n/a Goal: Safety/Well-Being/Permanency: n/a Data Source: Universal database of claims records from all health care payers, which could be expanded to include other types of health records. Could broaden the data field against which to conduct comparative effec- tiveness research and develop children’s quality measures. Limitations: Does not exist today STATE-DESIGNED MULTISOURCE, INCLUDING COMMERCIAL, DATABASES Current Established Child Measures in a Data System That Supports Benchmarking: n/a

OCR for page 289
322 CHILD AND ADOLESCENT HEALTH Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: Multisource data verification and validation services. They com- bine data contained in a number of public systems, and create a search function that fits the state’s eligibility process. Age: Varies by system Frequency: Unknown Race/Ethnicity: Unknown Unit Level: Hospital, Physician, Clinic, MCO, State: Unknown Geography: State level Use: Improvement/Accountability: n/a Goal: Safety/Well-Being/Permanency: n/a Data Source: Public systems Limitations: n/a ASSURING BETTER CHILD HEALTH AND DEVELOPMENT (ABCD) I, II, III Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a

OCR for page 289
323 APPENDIX G Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: Through ABCD II, which began in October 2009, five states (Arkansas, Illinois, Minnesota, Oklahoma, and Oregon) will develop and test sustainable models for improving care coordination and linkages be- tween pediatric primary care providers and other providers who support children’s healthy development. Age: Birth to 5 years Frequency: Unknown Race/Ethnicity: Unknown Unit Level: Hospital, Physician, Clinic, MCO, State: Provider Geography: Within a state—subset of states: Arkansas, Illinois, Minnesota, Oklahoma, and Oregon Use: Improvement/Accountability: Improvement and accountability Goal: Safety/Well-Being/Permanency: Well-being Data Source: Iowa: identified billing codes that would allow claims data to identify whether a screening assessment and diagnosis of developmental, social, and emotional or family risk concerns occurred that could be used as a data source if the preventive medicine codes were widely used. They include 99381–99383 for preventive medicine services for new patients for developmental, social, emotional, and family risk status as part of the com- prehensive well-child exam. For established patients, 99391–99393, and for limited developmental testing, 96110. Extended developmental testing, which would include the Bayley Scales of Infant Development, Woodcock- Johnson Test of Cognitive Abilities, and Peabody Picture Vocabulary Test, may also be billed and reported separately or with another code such as an EandM code. Limitations: n/a

OCR for page 289
324 CHILD AND ADOLESCENT HEALTH CHIP ANNUAL REPORTING TEMPLATE SYSTEM (CARTS) Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: Information: child, family, income, premiums, premium struc- tures, deductibles, and assets. Seven measures: well-child visits in the first 15 months of life, and 3rd, 4th, 5th, and 6th years of life; use of appropriate medications for asthma; and access to primary care. Measures based on HEDIS, but use of HEDIS methodology is not required. State must provide: measurement specification, population covered, data source, age, whether there is a continuous enrollment requirement, and type of delivery system. Age: Reported by age groupings Frequency: Annually—federal fiscal year (FFY) reported by January 1 of following year Race/Ethnicity: Not by measure Unit Level: Hospital, Physician, Clinic, MCO, State: State Geography: State Use: Improvement/Accountability: Improvement and accountability Goal: Safety/Well-Being/Permanency: n/a Data Source: Claims, hybrid of claims and medical records, survey, or other Limitations: State flexibility regarding income standards and eligibility parameters, such as disregards and small numbers

OCR for page 289
325 APPENDIX G STATE MEDICAID EFFORTS THAT FOCUSED ON CHILDREN Current Established Child Measures in a Data System That Supports Benchmarking: n/a Current Established Child Measures: n/a Current Other Measurement Activities Using Various Child Measures, In- cluding Established Measures and Indicators: n/a Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: n/a Other Activities Producing Data That Could Potentially Be Used for Mea- surement: Minnesota links birth certificates with Medicaid deliveries in order to identify Medicaid births. The methodology will be implemented as a data linkage protocol for Minnesota. Oregon has done preliminary work through the Public Health Medicaid Assessment Initiative (PHMAI) on the use of claims data, including encounter data, for public health surveillance. Oregon has engaged in three processes: developing disease rosters using Medicaid claims data, collecting survey data, and linking survey and claims data. Age: Unknown Frequency: Unknown Race/Ethnicity: Unknown Unit Level: Hospital, Physician, Clinic, MCO, State: State Geography: State-specific Use: Improvement/Accountability: Eligibility Goal: Safety/Well-Being/Permanency: n/a Data Source: Medicaid claims and eligibility; birth records Limitations: Oregon has identified two data system issues that impact the feasibility of the use of claims data—the eligibility system and the MCO enrollment data system. Issues include: standard case definitions are lack- ing; some case definitions contain criteria; and some case definitions require variables that are not available for the entire Medicaid population in all states, such as pharmacy claim information.

OCR for page 289