Emerging Measures
Contents
Child and Adolescent Health Measurement Initiative (CAHMI)
ORYX™
The increasing demand for and use of
quality measurement information generates interest in developing new
measures in areas for which none exists, as well as refining and updating
measures already in use. Organized and funded quality measure development
activities are ongoing. This section focuses on selected measures that
are undergoing extensive development.
Updating and refinement of measures
in established quality measurement sets such as the Consumer Assessment
of Health Plans (CAHPS®), AHRQ Quality Indicators (AHRQ QIs), Health
Plan Employer Data and Information Set (HEDIS®), and Title V Maternal
and Child Health Programs are ongoing.
Online Resources:
For more information on CAHPS®, go to: http://www.ahrq.gov/chtoolbx/measure2.htm
For more information on AHRQ QIs, go to: http://www.ahrq.gov/chtoolbx/measure3.htm
For more information on HEDIS®, go to: http://www.ahrq.gov/chtoolbx/measure4.htm
For more information on Title V Maternal and Child Health Programs, go to: http://www.ahrq.gov/chtoolbx/measure5.htm
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Child and Adolescent Health Measurement Initiative
The Child and Adolescent Health Measurement Initiative (CAHMI) has three multi-item survey measures that have undergone extensive development activities and will be available in 2004. They are:
The Data Resource Center for Child and Adolescent Health allows users to search and display charts and tabular findings from individual survey items as well as derived key child health measures from these data sources.
Online Resource:
To access the Data Resource Center (DRC) for Child and Adolescent Health, go to: http://www.childhealthdata.org
Ambulatory Care Sensitive Hospitalization Measurement Project
The purpose of this project is to develop
and test a standardized set of measures to assess the effectiveness
of Medicaid managed care organizations, primary care case management
programs, and ambulatory fee-for-service programs in delivering appropriate
and timely care for conditions common in childhood.
Information for these measures will
be obtained through administrative claims data on hospitalizations for
each of the following age groups: 0-1, 2-4, 5-9, and 10-14 years. Some hospitalizations are considered avoidable with timely and appropriate primary care services. CAHMI is working with States and experts to specify and test alternative approaches to constructing measures useful for State policymakers.
Specifications and tool kits for using the measurements will be made available through the CAHMI Web site. Further information is available through CAHMI staff at cahmi@ohsu.edu.
Online Resources:
For more information on CAHMI, go to: http://www.ahrq.gov/chtoolbx/measures.htm
For the CAHMI Web site, go to: http://www.cahmi.org
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Medical Home for Children with Special Health Care Needs (CSHCN)
The purpose of this project is to develop,
test, and gain consensus on a uniform strategy for measuring medical
home for Children with Special Health Care Needs at both State and Federal
levels. The project uses existing national surveys, such as:
- The National Survey of Children's Health, sponsored by the Maternal and Child Health Bureau.
- The Medical Expenditure Panel Survey (MEPS).
Under the Title V Maternal and Child
Health Programs, each State is required to report on CSHCN who have
access to a medical home. The criteria established by each State vary
widely since no standard definition exists. By using existing data,
as well as by drawing on the knowledge and experience of consumers and
professionals in the field, this project will establish a standardized
way to measure medical home access.
An expert advisory group has been working
to guide the development of a measure and technical specifications,
and to work with survey sponsors to identify gaps in available data
to construct an "ideal" measure. Models for measuring medical home
using the CAHPS® survey will be available on the CAHMI Web site in 2004. Models for measuring medical home using data from the National
Survey of Children with Special Health Care Needs, a national survey
conducted by the Centers for Disease Control and Prevention, will be
available late in 2004 on the CAHMI Web site.
Online Resources:
For the National Survey of Children with Special Health Care Needs, go to: http://www.cdc.gov/nchs/slaits.htm#Contact%20SLAITS
For the CAHMI Web site, go to: http://www.cahmi.org
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Mental and Behavioral Health Quality Measures for Children and Adolescents
This project assesses the potential of using the CAHPS® data to yield potential measures for monitoring the quality of behavioral and mental health care to children and adolescents.
This project was developed under CAHMI with support from the Centers for Medicare &
Medicaid Services. It focuses on identifying methods and strategies
for using available data to evaluate the quality of mental and behavioral
health services to children and adolescents enrolled in Medicaid. Given
the significant percentage of Medicaid funds spent on mental health
services for children and adolescents, State and Federal policymakers
are looking for ways to assess the quality of these services. The measures
identified in this project are expected to have application in non-Medicaid
populations as well.
Tools developed from this work will use existing data to determine whether
mental or behavioral health services have been used. Thus, these measures
will be targeted to the general population of children who may not be
identifiable in the mental or behavioral health service system.
The project has two phases. In Phase I, an expert advisory group was established
to assess the potential of using CAHPS® data to yield
potential measures for assessing the quality of behavioral and mental
health care to children and adolescents. Existing gaps in current measurement
also were identified.
Phase II involves a six-stage development process:
- Develop a scientific paper on a conceptual framework
for development of measures.
- Conduct a focused literature review.
- Conduct consumer focus groups to identify which areas
of quality consumers perceive to be of greatest relevance.
- Establish and obtain input from an expanded advisory
group.
- Develop a measurement proposal.
- Select options for further development and design
a protocol for field testing.
Models for analyzing CAHPS® data to measure
mental and behavioral health for children and adolescents will be available
on the CAHMI Web site in 2004.
Online Resource: For the CAHMI Web site, go to: http://www.cahmi.org
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ORYX™
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has long been the designated accreditation agency for hospitals and other health care facilities. In 1997, JCAHO added quality measurement requirements to existing requirements for participation in the accreditation process for hospitals and long-term
care facilities in an initiative called ORYX™.
The ORYX™ initiative requires hospitals
and long-term care organizations to:
- Identify and begin to use existing quality
measurement systems.
- Produce quality measurement results as a
part of the JCAHO accreditation process.
JCAHO-accredited providers of other
types of health care, such as home care and hospice, behavioral health
care, and pathology and clinical laboratory services, will be required
to participate in ORYX™ as the initiative is fully implemented.
In 2001, JCAHO announced four Core
Measure Set Areas for introduction into the JCAHO hospital accreditation
program. They are:
- Acute myocardial infarction (including coronary
artery disease).
- Heart failure.
- Pneumonia (community acquired).
- Pregnancy and related conditions (including newborn
mortality).
Children's asthma care is under consideration as a
candidate core measure set. Through a collaborative effort initiated
by JCAHO with five national Children's health organizations—Child Health Corporation of America, Medical Management Plan, National Association of
Children's Hospitals and Related Institutions, National Initiative of
Children's Healthcare Quality, and the Nemours Foundation—the following
asthma care measures were identified:
- Asthma unplanned readmission within 7 days following
discharge.
- Asthma unplanned readmission within 30 days following
discharge.
- Return to the emergency department within 48
hours following inpatient stay for asthma.
- Use of systemic corticosteroids for inpatient
asthma by age group.
- Use of relievers for inpatient asthma by age
group.
- Risk-adjusted average length of stay for asthma
patients.
These asthma care measures have received public comment
and may undergo further testing and refinement. More information about
ORYX™ core measures and candidate measures are available through the
JCAHO Web site.
The ORYX™ measurement initiative deals
with accreditation of health care organizations and is not designed
for use by health care purchasers or regulators. However, as the ORYX™
initiative progresses, States might find it useful to learn the ORYX™
status of the health care organizations that are providing care to people
enrolled in child health and other publicly funded health care programs.
Online Resources:
For the JCAHO Web site, go to: http://www.jcaho.org/
For more information on ORYX™, go to: http://www.jcaho.org/pms/core+measures/index.htm
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Internet Citation:
Child Health Care Quality Toolbox: Emerging Measures. June 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/chtoolbx/emerging.htm