title: Identifying children's health care quality measures for Medicaid and CHIP: an evidence-informed, publicly transparent expert process.
abstract: OBJECTIVE
  To describe the process used to identify the recommended core set of quality measures as mandated by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and provide an overview of the measures selected.
  
  
  METHODS
  In May 2009, the multidisciplinary Agency for Healthcare Research and Quality (AHRQ) National Advisory Council for Healthcare Research and Quality Subcommittee on Children's Healthcare Quality Measures for Medicaid and CHIP Programs (SNAC) was formed. The SNAC established criteria to evaluate quality measures on the basis of their validity, feasibility, and importance. Subsequently, AHRQ implemented a measure nomination process. Nominators supplied key information related to measure validity, feasibility, and importance. Oxford Centre for Evidence-Based Medicine (CEBM) criteria were used to assess evidence supporting the validity/scientific soundness of nominated measures. SNAC members applied an adaptation of the RAND-UCLA modified Delphi process to all nominated measures. Measures passing the Delphi process were further assessed on the basis of criteria pertaining to legislative priorities.
  
  
  RESULTS
  Seventy of 119 nominated measures met criteria for validity, feasibility, and importance according to Delphi scoring. After further prioritization, 25 measures were recommended for the initial core set. Twelve of the recommended measures focus on preventive care and health promotion including prenatal/perinatal care (4), well-child care (1), immunizations (2), screening for: developmental delays (1), obesity (1), and sexually transmitted infections (1), and receipt of preventive dental services (2). Five acute care measures were recommended which focus on management of upper respiratory illnesses (2), receipt of acute care dental services (1), emergency department utilization (1), and inpatient rates of central line associated bloodstream infections (1). Five of the recommended measures focus on chronic care, specifically asthma (1), attention-deficit/hyperactivity disorder (1), diabetes (1), and care for children with mental health conditions (2). Two of the measures focus on family experiences with care, and one of the measures assesses utilization of outpatient primary care services. Thirteen (52%) of the measures were derived from the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS). Eighteen of the measures were supported by relatively high levels of evidence (Oxford CEBM grade A or B).
  
  
  CONCLUSIONS
  An open national public process combined with an evidence-informed evaluation methodology resulted in identification of a balanced, grounded, and parsimonious core set of measures that should become feasible to implement on a widespread scale over time.
authors.affiliation: Department of Pediatrics, University of Washington, Center for Child Health, Behavior and Development, Seattle Children’s Hospital Research Institute, 1100 Olive Way, Suite 500, Seattle, Washington 98101, USA. Rita.Mangione-Smith@seattlechildrens.org
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schiff
authors.forename: Denise
authors.initials: D
authors.lastname: Dougherty
mesh_terms: D002648:Child; D002662:Child Health Services / Q000331:legislation & jurisprudence / Q000592:standards*; D002669:Child Welfare / Q000331:legislation & jurisprudence*; D003697:Delphi Technique; D006293:Health Promotion / Q000331:legislation & jurisprudence / Q000592:standards; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence* / Q000592:standards; D008484:Medicaid / Q000331:legislation & jurisprudence / Q000592:standards*; D017064:Process Assessment, Health Care / Q000458:organization & administration; D019984:Quality Indicators, Health Care; D014481:United States; D016270:United States Agency for Healthcare Research and Quality