Center of Excellence on Quality of Care Measures for Children with Complex Needs

描述（由申请人提供）：与儿童相关的研究和政策侧重于扩大公共保险计划的资格，但扩大对不提供必要服务的系统的访问将不会产生最佳结果。如果要制定和实施缩小差距的适当战略，就必须确定提供保健服务方面的缺陷。《儿童健康保险计划再授权法案》（CHIPRA）第四章要求美国卫生与公众服务部部长确定并发布一套初步的、推荐的核心儿童医疗保健质量措施，供医疗补助和儿童健康保险计划（CHIP）自愿使用，征求公众意见。虽然这一套最初的核心措施是一个良好的开端，但这只是制定一套严格、标准化的措施的长期过程中的第一步，这些措施将有助于对改善儿童保健质量的优先事项进行例行质量评估和指导。在选择CHIPRA立法规定的最初一套核心措施期间，发现了若干缺陷。其中包括缺乏针对特定类型的护理和护理环境的措施，以及无法充分收集有关种族、族裔和特殊保健需求状况的数据，以监测护理的变化和差异。此外，没有确定评估“大多数综合卫生保健设置”的质量措施。为了这个项目，我们组建了一个复杂需求儿童护理质量措施卓越中心（COE4CCN）。COE4CCN汇集了一群不同的、有才能的组织和个人，他们有专业知识和能力来严格开发和测试解决上述所有缺陷领域的质量措施。COE4CCN包括以下领域的专家：调查措施制定、循证过程措施制定（使用医疗记录和/或行政数据）、风险调整、评估差异，以及适当识别和将有特殊卫生保健需求的儿童划分为有意义的风险类别。此外，COE4CCN汇集了几个关键领域的内容专家，包括医疗之家、CSHCN护理、儿童和青少年心理和行为健康、青少年慢性疾病管理、种族/民族差异和健康信息学。几个关键的利益相关者团体也将成为COE4CCN的组成成员，包括两个州（西澳和MN）的医疗补助和CHIP项目的代表，西澳和MN的AAP分会的代表，以及MN家庭之声的代表。COE4CCN将有能力制定有意义的、严格设计的、可传播的质量措施，这些措施可在国家一级使用，以跟踪和改善向美国儿童提供的护理质量。

DESCRIPTION (provided by applicant): Research and policy related to children has focused on expanding eligibility for public insurance programs, but expanding access to a system that does not deliver necessary services will not result in optimal outcomes. Deficits in care delivery must be identified if appropriate strategies to close the gaps are to be developed and implemented. Title IV of the Child Health Insurance Program Reauthorization Act (CHIPRA) called for the Secretary of the U.S. Department of Health and Human Services to identify and post for public comment an initial, recommended core set of children's health care quality measures for voluntary use by Medicaid and Children's Health Insurance Programs (CHIP). While this initial core set of measures represents a good starting place, it is just the first step in a long term process to develop a rigorous, standardized set of measures that will facilitate routine quality assessment and guidance on priorities for improving children's healthcare quality. Several deficits were identified during the selection of the initial core set of measures mandated by the CHIPRA legislation. These included a dearth of measures for particular types of care and care settings as well as an inability to adequately collect data on race, ethnicity, and special health care need status to monitor variations in care and disparities. Additionally, no quality measures were identified that assess "most integrated health care settings." For this project we have assembled a Center of Excellence on Quality of Care Measures for Children with Complex Needs (COE4CCN). The COE4CCN brings together a diverse and talented group of organizations and individuals who have the expertise and capacity to rigorously develop and test quality measures that address all of the above mentioned areas of deficit. The COE4CCN includes experts in the areas of survey measure development, evidence-based process measure development using medical records and/or administrative data, risk adjustment, assessing disparities, and appropriately identifying and stratifying children with special health care needs into meaningful risk categories. Additionally, the COE4CCN brings together content experts in several key areas including the medical home, caring for CSHCN, child and adolescent mental and behavioral health, chronic disease management in adolescents, racial/ethnic disparities, and health informatics. Several key stakeholder groups will also be integral members of the COE4CCN, including representatives from Medicaid and CHIP programs in two states (WA and MN), representatives from the AAP Chapters in WA and MN, and representatives from MN Family Voices. The COE4CCN will have the ability to develop meaningful, rigorously designed, disseminable quality measures that can be used at the national level to both track and improve on the quality of care provided to US children. PUBLIC HEALTH RELEVANCE: The quality of care measures we propose to develop under this award will provide new tools to rigorously and comprehensively evaluate health care for children with complex needs. Without such measurement tools, it is not possible to assess where deficits exist and how to target efforts to best improve care. These measures will be designed for dissemination and use among all Medicaid and Child Health Insurance Programs (CHIP) nationally.