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一直专注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不会产生最佳结果。如果要制定和执行适当的战略来弥补差距，就必须查明在提供保健方面的缺陷。《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公布一套初步的、推荐的儿童医疗保健质量核心措施，供医疗补助和儿童健康保险计划（CHIP）自愿使用。虽然这套初步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的第一步，这套措施将促进例行的质量评估，并就提高儿童保健质量的优先事项提供指导。在选择《健康和知识产权法》立法规定的一套初步核心措施时，发现了一些不足之处。这些问题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、族裔和特殊医疗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“最综合的卫生保健环境”的质量措施。“对于这个项目，我们组建了一个具有复杂需求的儿童护理措施质量卓越中心（COE 4CCN）。COE 4CCN汇集了一群多元化的组织和个人，他们拥有专业知识和能力，可以严格开发和测试解决上述所有缺陷领域的质量措施。COE 4CCN包括调查措施制定、使用医疗记录和/或行政数据制定循证过程措施、风险调整、评估差异以及适当识别和将具有特殊医疗保健需求的儿童划分为有意义的风险类别等领域的专家。此外，COE 4CCN汇集了几个关键领域的内容专家，包括医疗之家，照顾CSHCN，儿童和青少年心理和行为健康，青少年慢性病管理，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COE 4CCN的不可分割的成员，包括来自两个州（WA和MN）的医疗补助和CHIP计划的代表，来自WA和MN的AAP分会的代表，以及MN家庭之声的代表。COE 4CCN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用于跟踪和改善为美国儿童提供的护理质量。 公共卫生相关性：我们建议在该奖项下制定的护理质量措施将提供新的工具，以严格和全面地评估具有复杂需求的儿童的医疗保健。如果没有这种衡量工具，就不可能评估哪里存在缺陷，以及如何有针对性地努力以最佳方式改善护理。这些措施将在全国所有医疗补助和儿童健康保险计划（CHIP）中传播和使用。

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.