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Pediatric Performance Measurement: Florida's Experiences with CHIPRA . External Quality Review Quarterly Meeting May 22, 2013 Caprice Knapp, PhD. Quality of Care in Pediatrics. 2011 IOM report “ Child Health and Child Health Outcomes ” - PowerPoint PPT Presentation
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PEDIATRIC PERFORMANCE MEASUREMENT: FLORIDA'S EXPERIENCES WITH CHIPRA External Quality Review Quarterly Meeting May 22, 2013Caprice Knapp, PhD
QUALITY OF CARE IN PEDIATRICS 2011 IOM report “Child Health
and Child Health Outcomes”
Health care expenditures are high (17% GDP), & outcomes are sub-par (Infant Mortality, Preventive Care)
Quality for the past 30 years has been primarily focused on adult and inpatient measures
CHILD HEALTH QUALITY IS FINALLY IN THE SPOTLIGHT! ACA
National Quality Strategy Medicaid Pediatric Rate Increase
CHIPRA - 24 core pediatric measures
Reauthorization of CHIP - increased reporting
• Each increases accountability, reporting, and places an emphasis on quality measures
• Expect more emphasis on reporting and quality improvement in the future (MOC, etc)
CHILDREN’S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT (CHIPRA)
GOALS OF CHIPRA Development of a core set of measures Creation of new measures Create an EHR format for children Provider-based initiatives (stay tuned….) Authorization of $20M to the Census Bureau
to improve child-specific population estimates
Streamline enrollment
24 CORE CHIPRA MEASURES Measure selection process Stakeholders: NQF, NCQA, AAP, AHRQ,
NICHQ, etc. Based on administrative, hybrid,
registry, and survey data Benchmarks do not exist 18 states are participating in Part A Noticeable gaps- mental health,
substance abuse, end of life, disparities In 2011, Florida reported on 20/24 In 2012, Florida reported on 22/24
DATA SOURCES FOR MEASURE CALCULATION – 2012
2012 DASHBOARD
Prevention and Health Promotion There are 13 preventive and health promotion measures. As compared to national benchmarks, Florida’s performance
is strong and slightly below the benchmark.
Management of Acute Conditions There are three measures that assess management of acute
conditions. Florida has more room for improvement on these measures
as compared to the others. Dashboard Key
Benchmark Performance
Management of Chronic Conditions Of the three measures that assess the management of
chronic conditions, Florida has average performance that is slightly below national benchmarks.
Family Expectations of Care
Florida has the strongest performance in the family expectations of care measures. Results are roughly equal to the national benchmarks.
Dashboard Key
Benchmark Performance
POTENTIAL MEASURES FOR IMPROVEMENT
Prenatal Care
Immunizations
Developmental
Screening
Ambulatory Care
Dental Care
Frequency of on going prenatal care (FPC)
Childhood Immunization Status (CIS) Combo 3
Development screening in the first 3 years of life
Preventive dental services
Timeliness of prenatal care (PPC)
Emergency department visits
Areas Measures
Dental treatments
HEDIS ADMINISTRATIVE MEASURES 2012
HEDIS ADMINISTRATIVE MEASURES Florida Met
Children and Adolescents’ Access to Primary Care Practitioners: Members 12 months to 25 months of age (CAP)
Follow-Up Care for Children Prescribed ADHD Medication (ADD) – Continuation and Maintenance Phase
Follow-Up Care for Children Prescribed ADHD Medication (ADD) – Initiation Phase
Florida Did Not Meet Chlamydia Screening (CHL) Children and Adolescents’ Access to Primary Care
Practitioners: Members 25 months to 6 years of age (CAP)
Children and Adolescents’ Access to Primary Care Practitioners: Members 7 to 11years of age (CAP)
Children and Adolescents’ Access to Primary Care Practitioners: Members 12 to 19 years of age (CAP)
Follow-Up After Hospitalization for Mental Illness (FUH) Appropriate Testing for Children With Pharyngitis (CWP) Ambulatory Care: Emergency Department Visits (AMB)
APPROPRIATE TESTING FOR CHILDREN WITH PHARYNGITIS (CWP): BY PROGRAM TYPE
TXIX CMSN TXIX FFS TXIX PCCM TXIX HP TXXI MediKids TXXI Healthy Kids
0%
20%
40%
60%
80%
100%
60.5%51.6% 55.5% 60.4% 66.3% 67.0%
Rate
Title XIX Title XXI
Benchmark: 65.5%
3.4% 3.3% 6.2% 7.0% 6.6% 4.8%
11.1% 4.9% 3.6% 11.2%
FOLLOW-UP CARE FOR CHILDREN PRESCRIBED ADHD MEDICATION (ADD)- INITIATION PHASE BY PROGRAM
TXIX FFS TXIX PCCM TXIX HP TXXI Healthy Kids0%
20%
40%
60%
80%
100%
29.0%36.8% 41.5% 36.6%
Rate
Title XIX Title XXI
Benchmark: 35.7%
13.5% 5.9% 18.1%
FOLLOW-UP CARE FOR CHILDREN PRESCRIBED ADHD MEDICATION (ADD): CONTINUATION AND MAINTENANCE PHASE BY PROGRAM
TXIX FFS TXIX HP TXXI Healthy Kids0%
20%
40%
60%
80%
100%
27.7%
53.5%38.6%
Rate
Title XIX Title XXI
Benchmark: 42.1%
NON-HEDIS ADMINISTRATIVE MEASURES 2012
NON-HEDIS ADMINISTRATIVE MEASURES These Measures Include:
Total Eligibles Who Received Preventive Dental Services
Total Eligibles Who Received Dental Treatment Services
Annual Number of Asthma Patients with ≥ 1 Asthma-Related Emergency Room Visit
0.9% 0.3% 0.3% 0.8% 0.1%
NUMBER OF ASTHMA PATIENTS WITH ≥1 ASTHMA-RELATED EMERGENCY ROOM VISIT: BY PROGRAM TYPE
TXIX CMSN TXIX FFS TXIX PCCM TXXI MediKids TXXI Healthy Kids
0%
20%
40%
60%
80%
100%
10.2% 13.9% 10.7% 9.6% 5.7%
Rate
Title XIX Title XXI
OPTIONAL HYBRID MEASURES 2012
OPTIONAL HYBRID MEASURES Florida Did Meet:
Well-Child Visits in the First 15 Months of Life (W15)
Florida Did Not Meet: Prenatal and Postpartum Care: Timeliness
of Prenatal Care (PPC) Frequency of Ongoing Prenatal Care (FPC) Weight Assessment and Counseling for
Nutrition and Physical Activity for Children and Adolescents: Body Mass Index for Children/Adolescents (WCC)
Well-Child Visits in the 3rd, 4th, 5th and 6th Years of Life (W34)
Adolescent Well-Care Visits (AWC)
0.2% 0.3% 1.3% 0.9% 0.3%
WELL-CHILD VISITS IN THE 3RD, 4TH, 5TH
AND 6TH YEARS OF LIFE (W34) BY PROGRAM
TXIX CMSN TXIX PCCM TXIX HP TXXI MediKids TXXI Healthy Kids0%
20%
40%
60%
80%
100%
77.0% 75.3% 75.7% 74.4%62.8%
Rate
Title XIX Title XXI
Benchmark: 71.8%
1.8% 1.3% 3.5% 0.7%
ADOLESCENT WELL-CARE VISITS (AWC) BY PROGRAM
TXIX CMSN TXIX PCCM TXIX HP TXXI Healthy Kids0%
20%
40%
60%
80%
100%
58.7%49.8% 48.1% 53.8%
Rate
Title XIX Title XXI
Benchmark: 46.8%
REGISTRY MEASURES 2012
REGISTRY MEASURES These Measures Include:
Percentage of Live Births Weighing Less than 2,500 grams
Cesarean Rate for Nulliparous Singleton Vertex
Childhood Immunization Status (CIS)*
Immunization for Adolescents (IMA)*
*Discussed on slide “What’s New in 2012?”
CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (CAHPS) 2012
COMPOSITES THAT FLORIDA HAS MET NATIONAL BENCHMARKS How Well Child’s Doctor
Communicates Customer Service Getting Needed Information Overall Ratings for Child’s Personal
Doctor Overall Ratings for Child’s
Specialist Overall Ratings for Child’s Health
Care Overall Ratings for Child’s Health
Plan
COMPOSITES THAT FLORIDA HAS NOT MET NATIONAL BENCHMARKS Getting Needed Care Getting Care Quickly Shared Decision Making Getting Specialized Services Coordination of Care and Services Personal Doctor Who Knows Child Getting Prescription Medicine
WHAT WAS NEW IN 2012? Improvements in the registry measures
Using FL SHOTS data greatly increased compliance for all three Immunizations for Adolescents submeasures for FHKC enrollees.
HYBRID MEASURE ANNUAL PEDIATRIC HEMOGLOBIN (HBA1C) TESTING AND CONTROL Comparison of results of administrative and
hybrid method
WHAT’S NEW IN 2013? Three new quality measures
Human Papillomavirus (HPV) Vaccine for Female Adolescents
Medication Management for People with Asthma Behavioral Health Risk Assessment for Pregnant
Women* Two retired measures
Otitis Media with Effusion – Avoidance of Inappropriate Systemic Antimicrobials in Children
CLASBI Florida will report 24/25 measures
SUMMARY Quality measurement is here to stay Measurement is not enough, the last
2 years of the CHIPRA grant will begin to focus on dissemination of information and ultimately, improvement.
What you do for Medicaid and CHIP enrollees matters!
THOSE WHO SAY IT CANNOT BE DONE SHOULD NOT INTERRUPT THE PERSON DOING IT.
-Chinese Proverb
CONTACT INFORMATION:The Institute for Child Health
Policy at the University of Florida
www. ichp.ufl.edu
Caprice Knapp, [email protected]