title: Are pediatric quality care measures too stringent?
abstract: BACKGROUND
  We aimed to demonstrate the application of national pediatric quality measures, derived from claims-based data, for use with electronic medical record data, and determine the extent to which rates differ if specifications were modified to allow for flexibility in measuring receipt of care.
  
  
  METHODS
  We reviewed electronic medical record data for all patients up to 15 years of age with ≥1 office visit to a safety net family medicine clinic in 2010 (n = 1544). We assessed rates of appropriate well-child visits, immunizations, and body mass index (BMI) documentation, defined strictly by national guidelines versus by guidelines with clinically relevant modifications.
  
  
  RESULTS
  Among children aged <3 years, 52.4% attended ≥6 well-child visits by the age of 15 months; 60.8% had ≥6 visits by age 2 years. Less than 10% completed 10 vaccination series before their second birthday; with modifications, 36% were up to date. Among children aged 3 to 15 years, 63% had a BMI percentile recorded; 91% had BMI recorded within 36 months of the measurement year.
  
  
  CONCLUSIONS
  Applying relevant modifications to national quality measure definitions captured a substantial number of additional services. Strict adherence to measure definitions might miss the true quality of care provided, especially among populations that may have sporadic patterns of care utilization.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, OR 27239, USA. casciato@ohsu.edu
authors.forename: Allison
authors.initials: A
authors.lastname: Casciato
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.forename: Christina
authors.initials: C
authors.lastname: Milano
authors.forename: Nicholas
authors.initials: N
authors.lastname: Gideonse
authors.forename: Rachel
authors.initials: R
authors.lastname: Gold
authors.forename: Jennifer
authors.initials: J
authors.lastname: DeVoe
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records; D005194:Family Practice; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000592:standards*; D017064:Process Assessment, Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies