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Acad Pediatr. 2014 Sep-Oct;14(5 Suppl):S76-81. doi: 10.1016/j.acap.2014.06.014.

Using Medicaid and CHIP claims data to support pediatric quality measurement: lessons from 3 centers of excellence in measure development.

Author information

1
RAND Corporation, Boston, Mass; Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: gidengil@rand.org.
2
Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Wash; Seattle Children's Research Institute, Seattle, Wash.
3
Children's Hospital of Philadelphia, Philadelphia, Pa.
4
Research and Data Analysis Division, Washington Department of Social and Health Services, Olympia, Wash.
5
Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, Calif.
6
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.
7
Office of the Medicaid Medical Director, Minnesota Department of Human Services, St Paul, Minn.
8
Harvard Medical School, Boston, Mass; Division of General Pediatrics, Boston Children's Hospital, Boston, Mass.
9
RAND Corporation, Boston, Mass; Harvard Medical School, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.

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.

KEYWORDS:

CHIP; Medicaid; quality measurement; value-based purchasing

PMID:
25169462
DOI:
10.1016/j.acap.2014.06.014
[Indexed for MEDLINE]

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