title: Systematic evidence-based quality measurement life-cycle approach to measure retirement in CHIPRA.
abstract: OBJECTIVE
  In 2009, Centers for Medicare and Medicaid Services (CMS) publicly released an initial child core set (CCS) of health care quality measures for voluntary reporting by state Medicaid and Children's Health Insurance Program (CHIP) programs. CMS is responsible for implementing the reporting program and for updating the CCS annually. We assessed selected CCS measures for potential retirement.
  
  
  METHODS
  We identified a 23-member external advisory group to provide relevant expertise. We worked with the group to identify 4 major criteria with multiple subcomponents for assessing the measures. We provided information corresponding to each criterion and subcriterion, using a variety of sources such as the 2009 Medicaid Analytic eXtract (MAX), state-level Medicaid and CHIP data submitted to the CMS, and summaries of published literature on clinical and quality improvement effectiveness related to the CCS topics. Using this information, the group: 1) used a modified Delphi process to score the measures in 2 anonymous scoring rounds (on a scale of 1 to 9 in each round); 2) voted on whether each measure should be retired; and 3) provided narrative explanations of their choices (which formed the basis of our qualitative findings). Recommendations were reviewed by CMS before promulgation to state programs.
  
  
  RESULTS
  The Subcommittee of the National Advisory Council on Healthcare Research and Quality (SNAC) recommended that the 4 major criteria be importance, scientific acceptability, feasibility, and usability. The SNAC recommended 3 measures for retirement: access to primary care; testing for strep before recommending antibiotics for pharyngitis; and annual HbA1c testing of children with diabetes. Explanations for suggesting retirement of the measures included: views that the well-visit measures were a better measure of access than the primary care measure; a likely ceiling effect (pharyngitis); and the paucity of clinical evidence and low prevalence (both for HbA1c). CMS recommended that state Medicaid and CHIP programs retire 2 of the recommended measures from the CCS, but retained the access to primary care measure.
  
  
  CONCLUSIONS
  Periodic reassessment of the value of health care quality measures can reduce reporting burden and allow measure users to focus on measures with higher likelihood of leading to improvements in quality of care and child health outcomes.
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, Md. Electronic address: Denise.dougherty@ahrq.hhs.gov.
authors.forename: Denise
authors.initials: D
authors.lastname: Dougherty
authors.affiliation: Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, Rockville, Md.
authors.forename: Kamila B
authors.initials: KB
authors.lastname: Mistry
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, Md.
authors.forename: Olivia
authors.initials: O
authors.lastname: Lindly
authors.affiliation: Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, Rockville, Md.
authors.forename: Maushami
authors.initials: M
authors.lastname: Desoto
authors.affiliation: Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services, Baltimore, Md.
authors.forename: Karen
authors.initials: K
authors.lastname: LLanos
authors.affiliation: Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, Rockville, Md.
authors.forename: Francis
authors.initials: F
authors.lastname: Chesley
mesh_terms: D026683:Advisory Committees; D014487:Centers for Medicare and Medicaid Services, U.S.; D002648:Child; D002662:Child Health Services / Q000331:legislation & jurisprudence / Q000592:standards; D002669:Child Welfare / Q000331:legislation & jurisprudence; D003697:Delphi Technique; D006801:Humans; D007348:Insurance, Health; D008484:Medicaid; D010372:Pediatrics / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D014481:United States
keywords: AHRQ; CHIPRA; CMS; quality measures