title: Using Medicaid and CHIP claims data to support pediatric quality measurement: lessons from 3 centers of excellence in measure development.
abstract: OBJECTIVE
  We sought to explore the claims data-related issues relevant to quality measure development for Medicaid and the Children's Health Insurance Program (CHIP), illustrating the challenges encountered and solutions developed around 3 distinct performance measure topics: care coordination for children with complex needs, quality of care for high-prevalence conditions, and hospital readmissions.
  
  
  METHODS
  Each of 3 centers of excellence presents an example that illustrates the challenges of using claims data for quality measurement.
  
  
  RESULTS
  Our Centers of Excellence in pediatric quality measurement used innovative methods to develop algorithms that use Medicaid claims data to identify children with complex needs; overcome some shortcomings of existing data for measuring quality of care for common conditions such as otitis media; and identify readmissions after hospitalizations for lower respiratory infections.
  
  
  CONCLUSIONS
  Our experience constructing quality measure specifications using claims data suggests that it will be challenging to measure key quality of care constructs for Medicaid-insured children at a national level in a timely and consistent way. Without better data to underpin pediatric quality measurement, Medicaid and CHIP will have difficulty using some existing measures for accountability, value-based purchasing, and quality improvement both across states and within states.
authors.affiliation: RAND Corporation, Boston, Mass; Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: gidengil@rand.org.
authors.forename: Courtney
authors.initials: C
authors.lastname: Gidengil
authors.affiliation: Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Wash; Seattle Children's Research Institute, Seattle, Wash.
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: L Charles
authors.initials: LC
authors.lastname: Bailey
authors.affiliation: Research and Data Analysis Division, Washington Department of Social and Health Services, Olympia, Wash.
authors.forename: Mary Lawrence
authors.initials: ML
authors.lastname: Cawthon
authors.affiliation: Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, Calif.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: McGlynn
authors.affiliation: Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Division of General Pediatrics, Boston Children's Hospital, Boston, Mass.
authors.forename: Mari M
authors.initials: MM
authors.lastname: Nakamura
authors.affiliation: Office of the Medicaid Medical Director, Minnesota Department of Human Services, St Paul, Minn.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schiff
authors.affiliation: Harvard Medical School, Boston, Mass; Division of General Pediatrics, Boston Children's Hospital, Boston, Mass.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
authors.affiliation: RAND Corporation, Boston, Mass; Harvard Medical School, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Schneider
mesh_terms: D000465:Algorithms; D002648:Child; D002662:Child Health Services / Q000592:standards*; D002669:Child Welfare / Q000331:legislation & jurisprudence*; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D008484:Medicaid; D010372:Pediatrics / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D014481:United States
keywords: CHIP; Medicaid; quality measurement; value-based purchasing