National Academies Press: OpenBook

Child and Adolescent Health and Health Care Quality: Measuring What Matters (2011)

Chapter: Appendix G: Administrative Data

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Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Frequency: Annually—calendar year (continuous enrollment defined differently 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 Benchmarking: 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, 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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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 Medicaid 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 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]). 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, Tennessee MCOs required to report HEDIS in conjunction with their NCQA accreditation, and Nebraska requires the most recent HEDIS encounter data.

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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

Frequency: Annually—calendar year (continuous enrollment defined differently 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), medical 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 multiple plans, dental care, interpreter, Medicaid enrollment, personal doctor,

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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 access to reporting measures as well as guidelines that reflect “best practices” in reporting.

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: Adults aged 18 and older and children aged 17 and younger. Patient completes the adult questionnaire, while patient’s parent or guardian completes 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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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 hospitalization 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 nationally 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 screening and counseling on risky behaviors, sexual activity and sexually transmitted 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, 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

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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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 referral 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 management, 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 performance that measure clinical process, clinical outcomes, service data, and patient safety. For the clinical process and outcome measures, NCQA Diabetes 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, 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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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 collection 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 medication 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 pneumothorax 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 assessment on admission, periodic pain assessment, length of stay (LOS), mortality 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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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, 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: 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 measures and 4 measures in back pain selected for adult PQRI quality measures, there are a significant number of measures for children or for which children are included in the denominator. PQRI measure specifications: title,

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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 pharyngitis, 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 inappropriate 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, 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: 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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

denominator. The denominator population is defined by certain International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis, CPT Category I, and Healthcare Common Procedure 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: 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 (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 Measurement: n/a

Age: Measure-specific

Frequency: Annually—calendar year (continuous enrollment defined differently for Medicaid than for commercial plans)

Race/Ethnicity: State determined: quality improvement (QI) projects include breakout by race/ethnicity/special needs

Unit Level: Hospital, Physician, Clinic, MCO, State: MCO

Geography: States that contract with MCOs for Medicaid

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Use: Improvement/Accountability: Improvement and accountability

Goal: Safety/Well-Being/Permanency: Well-being

Data Source: Administrative data/claims data, medical records, consumer experience (CAHPS); some use CAHMI tools, and some use state-specific QI projects

Limitations: n/a

EXTERNAL QUALITY REVIEW ORGANIZATION (EQRO)

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: Regulations require states with managed care organizations (MCO) or prepaid inpatient health plans (PIHP) to conduct External Quality Review (EQR), including analysis and evaluation by EQRO of aggregated information on quality, timeliness, and access to the health care services, and produce an annual technical report for the state (would become a part of the state’s managed care quality strategy). States can perform tasks directly; hire multiple EQROs to perform three mandatory EQR activities; and/or hire multiple EQROs to perform optional EQR activities, including satisfaction surveys, clinical studies, and encounter data validation, with federal financial participation (FFP) varying depending upon the entity. Three mandatory activities: review of MCO/PIHP compliance with state-specified standards for quality program operations, validation of state-required performance measures, and validation of state-required performance improvement projects.

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

Frequency: Annually

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Race/Ethnicity: Often collected—not always reported

Unit Level: Hospital, Physician, Clinic, MCO, State: MCO level rolled up to state level in some cases

Geography: All states with Medicaid MCO contracts

Use: Improvement/Accountability: Improvement and accountability

Goal: Safety/Well-Being/Permanency: Well-being

Data Source: HEDIS, CAHPS, state-specific tools

Limitations: n/a

CMS NATIONAL MEDICAID QUALITY FRAMEWORK

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: Framework does not develop technical quality standards, but provides some key strategies across many domains of care in Medicaid, including preventive care, episodic acute care, chronic medical care, long-term care, and end-of-life care. For example, the framework includes consensus goals, such as every enrollee having a medical home for primary care, full immunization following Centers for Disease Control and Prevention (CDC) standards, avoidance of medical errors. Part of project is to provide CMS, state Medicaid agencies, EQROs, and other stakeholders with HEDIS results from as many Medicaid MCOs as possible.

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: See HEDIS/CAHPS

Frequency: Annually

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Race/Ethnicity: Potentially collected/not publicly reported

Unit Level: Hospital, Physician, Clinic, MCO, State: MCO with state

Geography: Multiple states

Use: Improvement/Accountability: Improvement and accountability

Goal: Safety/Well-Being/Permanency: Well-being

Data Source: HEDIS/CAHPS collection

Limitations: n/a

STATE MEDICAID- AND CHIP-SPECIFIC MEASURES

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: Oklahoma’s SoonerCare Choice PCCM: HEDIS child measures, including dental access; cervical cancer screening; % children who had their annual child checkup under early and periodic screening, diagnosis, and treatment (EPSDT) standards; % children who had at least one primary care provider visit in past calendar year (CY); diabetic care; and asthma care. SoonerCare Choice Surveys: CAHPS and ECHO (behavioral health services). North Carolina (Carolina ACCESS and Community Care of North Carolina) PCCM: HEDIS measures for effectiveness of care (breast, cervical, and colon cancer screening; diabetes and asthma care; children’s and adolescents’ vaccinations; and medical home (MH) follow-up after hospital discharge); availability-of-care measures (children’s access to primary care, adults’ access to preventive ambulatory services, and prenatal care); use-of-service measures (well-child visits, ambulatory care, and inpatient utilization); and frequently selected procedures. California, Georgia, Iowa, Louisiana, Massachusetts, and Washington access vital records information—will potentially improve reporting for quality.

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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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

Age: Measure-specific

Frequency: Annually

Race/Ethnicity: Collected and may or may not be reported

Unit Level: Hospital, Physician, Clinic, MCO, State: Provider rolled up to state for PCCM public reporting

Geography: Subset of states

Use: Improvement/Accountability: Improvement and accountability

Goal: Safety/Well-Being/Permanency: Well-being

Data Source: Mostly claims data, but some states have utilized the National Association for Public Health Statistics and Information Systems’ (NAPHSIS) Electronic Verification of Vital Events (EVVE), which allows users to interface with a system that queries all participating vital records jurisdictions irrespective of the place and date of issuance and provides a multistate system for birth certificate information.

Limitations: n/a

FEDERAL INTERAGENCY FORUM KEY INDICATORS

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: Indicators addressing children: family and social environment; economic circumstances; determinants of use of health services; physical environment and safety; personal behavior and its effects; how children learn and progress in school; and physical, mental, and social aspects of children’s health. Selection of indicators includes: understandability, objectivity, balance, regularity of measurement, and representativeness; % ages 0–17 covered by type of health insurance and selected characteristics; % ages 0–17 with no usual source of health

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

care by age, type of health insurance, and poverty status (1993–2007); % ages 19–35 months vaccinated for selected diseases by poverty status, race, and Hispanic origin (1996–2007); % ages 2–17 with dental visit by selected characteristics (1997–2007); % ages 2–17 with untreated dental caries by age, poverty status, race, and Hispanic origin (1999–2002 and 2003–2004).

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: 2–17 with sub of 2–5, 6–11, 12–17 for dental

Frequency: Annually

Race/Ethnicity: Most indicators: data based on gender, age, race (white, black or African American, American Indian or Alaska Native, Asian, or Native Hawaiian or Other Pacific Islander) and Hispanic origin, poverty status, parental education, region of the country, and family structure

Unit Level: Hospital, Physician, Clinic, MCO, State: National

Geography: National

Use: Improvement/Accountability: Improvement and accountability

Goal: Safety/Well-Being/Permanency: Safety, well-being, and permanency

Data Source: Varies by measure: National Health Interview Survey (NHIS); National Child Abuse and Neglect Data System (NCANDS) (voluntary, annual, national reporting system collects case-level data on reports alleging child abuse and neglect, results of these reports from state child protective services [CPS] agencies). Data on births/deaths collected by National Center for Health Statistics (NCHS) from the registration offices of all states, New York City, and Washington, DC, through the National Vital Statistics System (NVSS). Demographic information on birth certificates, such as race/ethnicity, provided by mother at the time of birth, while hospital records provide information on birth weight, and funeral directors and family members provide demographic information on death certificates. Medical certification of cause of death is provided by a physician, medical examiner, or coroner.

Limitations: Voluntary

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

NATIONAL CENTER FOR HEALTH STATISTICS (NCHS) DATA SYSTEMS

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: n/a

Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: NCHS has two major types of data systems: systems based on populations, containing data collected through personal interviews or examinations; and systems based on records, containing data collected from vital and medical records.

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

Age: n/a

Frequency: Some of the data collections are conducted annually, and others are conducted periodically

Race/Ethnicity: n/a

Unit Level: Hospital, Physician, Clinic, MCO, State: n/a

Geography: Includes only events occurring within the United States (50 states and the District of Columbia)

Use: Improvement/Accountability: n/a

Goal: Safety/Well-Being/Permanency: n/a

Data Source: Survey-based systems include the National Health and Nutrition Examination Survey (NHANES), NHIS, National Immunization Survey (NIS), National Survey of Family Growth (NSFG), State and Local Area Integrated Telephone Survey (SLAITS), and National Health Care Surveys (NHCS). The NVSS, though, is based on data provided through contracts between NCHS and vital registration systems operated in the various jurisdictions legally responsible for the registration of vital events, including births, deaths, marriages, divorces, and fetal deaths.

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Limitations: Data are provisional, based on a combination of counts of events provided by each reporting area and registered vital events processed into NCHS data files, and events may not have occurred in the specified month of the report. There is also considerable variability among the states in the procedures that are used to submit the counts of marriages and divorces, affecting their completeness, and some states do not report divorces (California, Georgia, Hawaii, Indiana, Louisiana, and Minnesota).

NATIONAL HOSPITAL DISCHARGE SURVEY (NHDS)

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: n/a

Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: Two collection systems: manual sample selection and transcription of information from hospital records to abstract forms by the hospital’s staff or by staff of the U.S. Bureau of the Census on behalf of NCHS; and an automated system in which NCHS purchases computer files containing electronic data files from commercial organizations, state data systems, hospitals, or hospital associations (approximately 45% of respondent hospitals).

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

Age: n/a

Frequency: Sampled monthly

Race/Ethnicity: Collected

Unit Level: Hospital, Physician, Clinic, MCO, State: n/a

Geography: National

Use: Improvement/Accountability: n/a

Goal: Safety/Well-Being/Permanency: n/a

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Data Source: Source: hospital records. Data elements: patient age group at time of admission (under 1 year, 1–14 years, 15–44 years, 45–64 years, 65–74 years, 75–84 years, 85 years and over, and age unknown); sex; race; ethnicity; marital status; date of admission (month-day-year), date of discharge (month-day-year), and surgery dates; discharge status; patient ZIP code; expected source(s) of payment; medical record number; information on diagnoses (one to seven 5-digit ICD-9-CM and procedure codes for some years, as well as dates of procedures for some years); hospital data (bed size, ownership, length of stay in days); weight; and geographic region. The NHDS was designed to sample approximately 20–25 discharges per month per hospital.

Limitations: There are public-use files, but as with most such files, they are not current (data available from 1979 to 1997) and do not have the same data elements for every year.

NATIONAL AMBULATORY MEDICAL CARE SURVEY (NAMC)

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: n/a

Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: Survey based on a sample of visits to nonfederally employed office-based physicians, excluding anesthesiologists, pathologists, and radiologists.

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

Age: n/a

Frequency: Annually

Race/Ethnicity: n/a

Unit Level: Hospital, Physician, Clinic, MCO, State: n/a

Geography: National survey

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Use: Improvement/Accountability: n/a

Goal: Safety/Well-Being/Permanency: n/a

Data Source: Data, collected from the physician, are obtained on patients’ symptoms, physicians’ diagnoses, and medications ordered or provided. The survey also provides statistics on the demographic characteristics of patients and services provided, including information on diagnostic procedures, patient management, and planned future treatment. Beginning with the 1992 survey year, only one data file has been produced annually that contains both patient visit and drug information.

Limitations: Survey cannot be used to find out how many people have a certain diagnosis but can be used to find out how many ambulatory care visits were made involving a certain diagnosis. Geographic region (Northeast, Midwest, South, and West) and metropolitan statistical area status are the only geographic designations in the files. Participation is voluntary. Public-use files are available, but data are relatively old for purposes of performance measurement.

NATIONAL HOSPITAL AMBULATORY MEDICAL CARE SURVEY (NHAMC)

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: n/a

Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: National sample of visits to the emergency departments (EDs) and outpatient departments of noninstitutional general and short-stay hospitals to collect data on the utilization and provision of ambulatory care services in these departments. Hospital-based ambulatory surgery centers and freestanding ambulatory surgery centers were added in 2010.

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

Age: n/a

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Frequency: Annually

Race/Ethnicity: Unknown

Unit Level: Hospital, Physician, Clinic, MCO, State: n/a

Geography: 50 states and District of Columbia, exclusive of federal, military, and Veterans Administration hospitals

Use: Improvement/Accountability: n/a

Goal: Safety/Well-Being/Permanency: n/a

Data Source: Demographic characteristics of patients; expected source(s) of payment; patients’ complaints; diagnoses; diagnostic/screening services, procedures; medication therapy; disposition; types of providers seen; causes of injury (ED and ambulatory surgery center only); and certain characteristics of the facility, such as geographic region and metropolitan status.

Limitations: Participation is voluntary, and meaningful estimates cannot be made on a state-level basis. Public-use files are available, but again the data are relatively old for purposes of performance measurement.

DEFENSE MEDICAL SURVEILLANCE SYSTEM (DMSS)

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: n/a

Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: Department of Defense DMSS active surveillance system has access to the health care records, including vaccination history, for a substantial percentage of active-duty defense personnel, which can be used to determine a temporal relationship between vaccination and % incidence of an adverse event. For use during the 2009 H1N1 pandemic, this system is being linked with the vaccine safety datalink (VSD) to increase the system’s specificity and sensitivity (also termed signal strengthening).

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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

Age: n/a

Frequency: Unknown

Race/Ethnicity: Unknown

Unit Level: Hospital, Physician, Clinic, MCO, State: n/a

Geography: Active-duty defense personnel

Use: Improvement/Accountability: n/a

Goal: Safety/Well-Being/Permanency: n/a

Data Source: Health care records, including vaccination history

Limitations: Limited to active-duty defense personnel

CMS REPOSITORY—VACCINES

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: n/a

Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: Repository for Medicare enrollees includes vaccination status, which means it includes limited information on children. However, CMS has developed unique billing codes to distinguish pandemic from seasonal influenza vaccine administration.

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

Age: n/a

Frequency: Ongoing

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Race/Ethnicity: Unknown

Unit Level: Hospital, Physician, Clinic, MCO, State: n/a

Geography: National

Use: Improvement/Accountability: n/a

Goal: Safety/Well-Being/Permanency: n/a

Data Source: Claims with unique billing codes

Limitations: Medicare Repository

CMS MEDICAID STATISTICAL INFORMATION SYSTEM (MSIS)

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: n/a

Data/Systems Available: Potential Opportunity to Be a Source for Child Measures: Mandatory reporting system for state Medicaid programs to CMS for eligibility, health insurance, income, home and community-based services (HCBS) waiver status, race, ethnicity, age, sex, and other core data elements for Medicaid/CHIP eligibles covered through expansion of Medicaid. Potential data source for HEDIS measures: well-child visits/preventive visits; asthma medications ages 10–17; % ages 6–12 years with ADHD follow-up; age 6+ follow-up after hospitalization for myocardial infarction (MI) (7 and 30 days); inpatient utilization; MH utilization; outpatient drug utilization; and dental treatment.

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

Age: n/a

Frequency: Reported quarterly, 45 days after the end of each quarter. States may opt to submit eligibility files on a delayed schedule in order to capture retroactive accretions.

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Race/Ethnicity: Collected

Unit Level: Hospital, Physician, Clinic, MCO, State: n/a

Geography: State-specific on a national basis for Medicaid/CHIP

Use: Improvement/Accountability: n/a

Goal: Safety/Well-Being/Permanency: n/a

Data Source: ICD-9-CM codes with transition to ICF-10-CM anticipated. Clinical data not included; however, that may evolve with the “meaningful use” reporting of quality measures. Specifications are established for definitions of terms, categories of services, record layouts, data formatting requirements, validation and encryption methods, and requirements for state-assigned unique personal identification. MSIS edits include data validation edits and distributional checks. Coding requirements are specified, and state Medicaid agency staffs are provided with the information they need to prepare and submit MSIS files.

Limitations: Two operational issues: validity and completeness of encounter data and gap created as a result of some states not reporting their CHIP programs through MSIS. Data as good as data at state source, and issues remain related to drug files, cross-walks to federal specifications, and eligibility because of variations in state requirements. MSIS data will not match one-to-one with the CMS 64 and CMS 37 data.

MEANINGFUL USE

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: 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: The CMS Notice of Proposed Regulation (NPRM) has established the proposed quality reporting that will be required for eligible

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Medicare and Medicaid providers to receive their incentive payments. Each eligible provider (EP) or eligible hospital (EH) will be asked to report on three to five measures. Measures under consideration are for hospitals, with additional optional ones for Medicaid hospitals and EPs. While most measures include children, some are child-specific, such as immunization.

Age: Measure-specific

Frequency: Annually

Race/Ethnicity: Unknown

Unit Level: Hospital, Physician, Clinic, MCO, State: To be determined

Geography: Provider level—national

Use: Improvement/Accountability: Accountability

Goal: Safety/Well-Being/Permanency: n/a

Data Source: State and federal repositories—to be established

Limitations: Regulations and guidance still in process, and “future” not current

10 STATE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) GRANTEES

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: 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: Implement and evaluate provider performance measures and utilize health information technologies such as pediatric electronic health records and other quality improvement initiatives to help establish

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

a national quality system for children’s health care through Medicaid and CHIP—measures to be determined.

Age: To be determined

Frequency: To be determined

Race/Ethnicity: To be determined

Unit Level: Hospital, Physician, Clinic, MCO, State: To be determined

Geography: Each state/group of states has different priority

Use: Improvement/Accountability: To be determined

Goal: Safety/Well-Being/Permanency: To be determined

Data Source: To be determined

Limitations: n/a

MEDICAID ELIGIBILITY SYSTEMS: PROGRAM CODES

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: 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: State Medicaid eligibility systems have core data elements that are needed for quality measurement; however, there are numerous limitations to the data.

Age: By birth date

Frequency: At redetermination but at least annually

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Race/Ethnicity: Collected

Unit Level: Hospital, Physician, Clinic, MCO, State: Enrollee individual level—not provider

Geography: n/a

Use: Improvement/Accountability: n/a

Goal: Safety/Well-Being/Permanency: n/a

Data Source: n/a

Limitations: Continuous enrollment requirement due to the interruptions in Medicaid/CHIP coverage that result from “churning” of children on and off Medicaid/CHIP enrollment; newborn may initially be added to the Medicaid program “automatically” under his/her mother’s identification number/code; not always possible to code the current distinct race/ethnicity breakouts.

POST-LICENSURE RAPID IMMUNIZATION SAFETY MONITORING (PRISM)

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: 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: Partnership between HHS and the insurance industry to allow access to vaccine exposure and outcome data, which establishes an active surveillance system that monitors the covered population for predefined adverse events, such as Guillain-Barré syndrome. In addition, PRISM is used to rapidly determine rates of unanticipated adverse events.

Age: n/a

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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, 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: 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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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, 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: Automated, Internet-based, passive surveillance system developed 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 postimmunization to determine rates of adverse events, which will then be reported to the VAERS.

Race/Ethnicity: Unknown

Unit Level: Hospital, Physician, Clinic, MCO, State: n/a

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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, 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: Six academic medical centers (The Johns Hopkins University, Boston University, Stanford University, Vanderbilt University, Columbia University, and Northern California Kaiser Permanente), which as an association 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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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, 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: 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 Immunology (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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

Limitations: This system is probably not a source of data that are immediately 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, 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: 20 hospital: anesthesia complications, diagnosis-related group (DRG) deaths, decubitus ulcer, failure to rescue, foreign body, iatrogenic pneumothorax, selected infections, multiple postoperative, accidental puncture 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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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, 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: 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 effectiveness 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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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: Multisource data verification and validation services. They combine 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, Including Established Measures and Indicators: n/a

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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: 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 between 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 comprehensive 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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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, 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: Information: child, family, income, premiums, premium structures, 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

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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, 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: 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 lacking; 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.

Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×

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Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
×
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×
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Suggested Citation:"Appendix G: Administrative Data." Institute of Medicine and National Research Council. 2011. Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, DC: The National Academies Press. doi: 10.17226/13084.
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Increasing public investments in health care services for low-income and special needs children and adolescents in the United States have raised questions about whether these efforts improve their health outcomes. Yet it is difficult to assess the general health status and health care quality for younger populations, especially those at risk of poor health outcomes, because the United States has no national information system that can provide timely, comprehensive, and reliable indicators in these areas for children and adolescents. Without such a system in place, it is difficult to know whether and how selected health care initiatives and programs contribute to children's health status.

Child and Adolescent Health and Health Care Quality identifies key advances in the development of pediatric health and health care quality measures, examines the capacity of existing federal data sets to support these measures, and considers related research activities focused on the development of new measures to address current gaps. This book posits the need for a comprehensive strategy to make better use of existing data, to integrate different data sources, and to develop new data sources and collection methods for unique populations. Child and Adolescent Health and Health Care Quality looks closely at three areas: the nature, scope, and quality of existing data sources; gaps in measurement areas; and methodological areas that deserve attention.

Child and Adolescent Health and Health Care Quality makes recommendations for improving and strengthening the timeliness, quality, public transparency, and accessibility of information on child health and health care quality. This book will be a vital resource for health officials at the local, state, and national levels, as well as private and public health care organizations and researchers.

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