Improving Child Health and Healthcare through Dissemination and Implementation of Pediatric Quality Measures

项目概要/摘要 在美国，孩子们应该得到的照顾和他们得到的照顾之间仍然存在很大的差距。 联邦儿科质量措施计划（PQMP）的创建是为了制定各种质量措施， 设置和目的。通过PQMP，我们获得了建立卓越中心的资金， 质量测量（CEPQM），以制定和测试儿童质量措施。与多个国家合作， 在与各利益攸关方合作的过程中，我们在对付款人、提供者和家庭至关重要的领域制定了措施。为 PQMP目前的传播和实施阶段，我们的具体目标是召开一个多学科的 合作伙伴团队，并与马萨诸塞州（MA）和纽约（NY）合作，以：（A）实地测试两项措施 确保各州、卫生计划和医院的有效性、可行性和可用性，并进一步开发 简化数据收集和衡量报告的战略;以及（B）使用业绩数据确定质量 改善（QI）目标，评估干预效果，并推动国家级的改善。我们选择了两个 我们的指标集：（1）儿科30天再入院，包括两个指标，全条件再入院 和下呼吸道感染再入院，和（2）儿科住院护理的家庭经验， 包括儿童医院消费者对医疗保健提供者的评估中包含的18项措施， 系统（儿童HCAHPS）调查。两个测量集都与相应的成人测量相协调 医疗保险和医疗补助服务中心（CMS）、其他付款人和许多美国医院使用。两 重新接纳措施和儿童HCAHPS已得到国家质量论坛的认可。此外，本发明还提供了一种方法， 全条件再入院和儿童HCAHPS由措施应用伙伴关系优先考虑， 分别于2015年和2014年列入CMS子核心集。我们的多学科合作伙伴关系 包括学术研究人员;来自MA和NY卫生部门的代表，外部质量审查 组织、健康计划和医院;以及来自医疗保健改善研究所的QI专家， 国家改进伙伴关系网络。我们亦会加强措施，例如测试 通过纳入电子健康记录数据，改善再入院病例组合模型， 出院当天的儿童HCAHPS，以增加参与。我们的QI战略将基于 实施科学的实践，并将包括对影响当前实施科学的背景因素的分析。 绩效，识别改进的关键驱动因素，制定中间过程措施，以及 当地的变化测试。减少可预防的再入院并改善住院护理的家庭体验 是我们卫生系统的最高优先事项之一。通过这个项目，我们的目标不仅是促进 关于如何有效应用措施的知识，但也要制定战略和工具， 适用于许多措施领域和整个国家的实施和护理改进。

PROJECT SUMMARY/ABSTRACT There remains a wide gap in the US between the care children should receive and the care they do receive. The federal Pediatric Quality Measures Program (PQMP) was created to develop quality measures for diverse settings and purposes. Through the PQMP, we received funding to establish the Center of Excellence for Quality Measurement (CEPQM) to develop and test child quality measures. Working with multiple states and stakeholders, we developed measures in areas of critical importance to payers, providers, and families. For the PQMP's current dissemination and implementation stage, our specific aims are to convene a multidisciplinary partnership team and collaborate with Massachusetts (MA) and New York (NY) to: (A) field test two measure sets to ensure validity, feasibility, and usability for states, health plans, and hospitals, and further develop strategies to streamline data collection and measure reporting; and (B) use performance data to define quality improvement (QI) goals, assess intervention effects, and drive state-level improvement. We have selected two of our measure sets: (1) pediatric 30-day readmissions, comprising two measures, All-Condition Readmissions and Lower Respiratory Infection Readmissions, and (2) family experience of pediatric inpatient care, comprising the 18 measures included in the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) Survey. Both measure sets are harmonized with the corresponding adult measures used by the Centers for Medicare and Medicaid Services (CMS), other payers, and many US hospitals. Both readmission measures and Child HCAHPS have been endorsed by the National Quality Forum. In addition, All-Condition Readmissions and Child HCAHPS were prioritized by the Measure Applications Partnership in 2015 and 2014, respectively, for inclusion in the CMS Child Core Set. Our multidisciplinary partnership includes academic researchers; representatives from MA and NY health departments, External Quality Review Organizations, health plans, and hospitals; and QI experts from the Institute for Healthcare Improvement and National Improvement Partnership Network. We will also enhance our measures; for instance, we will test improving the readmissions case-mix model through including electronic health record data, and administering Child HCAHPS on day of discharge to increase participation. Our QI strategies will be grounded in the theory and practice of implementation science and will include analysis of contextual factors that affect current performance, identification of key drivers of improvement, development of intermediate process measures, and local tests of change. Reducing preventable readmissions and improving family experience of inpatient care are among the highest priorities for our health system. Through this project, we aim not only to advance knowledge about how to apply measures effectively, but also to produce strategies and tools that can be applied to implementation and care improvement in many measure domains and across the entire country.