title: Measuring prevention more broadly: an empirical assessment of CHIPRA core measures.
abstract: OBJECTIVE
  To assess limitations of using select Children's Health Insurance Program Reauthorization Act (CHIPRA) core claims-based measures in capturing the preventive services that may occur in the clinical setting.
  
  
  METHODS
  We use claims data from ALL Kids, the Alabama Children's Health Insurance Program (CHIP), to calculate each of four quality measures under two alternative definitions: (1) the formal claims-based guidelines outlined in the CMS Technical Specifications, and (2) a broader definition of appropriate claims for identifying preventive service use. Additionally, we examine the extent to which these two claims-based approaches to measuring quality differ in assessments of disparities in quality of care across subgroups of children.
  
  
  RESULTS
  Statistically significant differences in rates were identified when comparing the two definitions for calculating each quality measure. Measure differences ranged from a 1.9 percentage point change for measure #13 (receiving preventive dental services) to a 25.5 percentage point change for measure #12 (adolescent well-care visit). We were able to identify subgroups based upon family income, rural location, and chronic disease status with differences in quality within the core measures. However, some identified disparities were sensitive to the approach used to calculate the quality measure.
  
  
  CONCLUSIONS
  Differences in CHIP design and structure, across states and over time, may limit the usefulness of select claims-based core measures for detecting disparities accurately. Additional guidance and research may be necessary before reporting of the measures becomes mandatory.
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Justin
authors.initials: J
authors.lastname: Blackburn
authors.affiliation: University of Alabama at Birmingham.
authors.forename: David J
authors.initials: DJ
authors.lastname: Becker
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Morrisey
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Bisakha
authors.initials: B
authors.lastname: Sen
authors.affiliation: Alabama Department of Public Health.
authors.forename: Cathy
authors.initials: C
authors.lastname: Caldwell
mesh_terms: D000293:Adolescent; D000407:Alabama / Q000453:epidemiology; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D002675:Child, Preschool; D036262:Empirical Research; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid / Q000458:organization & administration* / Q000706:statistics & numerical data; D011315:Preventive Medicine / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Administrative Data Uses; Child and Adolescent Health; Children’s Health Insurance Program (CHIP, SCHIP); Quality of Care / Patient Safety (Measurement)