Q-METRIC Implementation and Quality Improvement

项目摘要 到目前为止，在保健质量运动中对儿童缺乏重视的情况是显而易见的。质量差距 已经确定了儿科健康护理提供的许多领域;然而，对于几乎所有这些情况， 没有适当的儿科质量措施。为响应关于 合作研究示范和传播项目，我们提出了Q-METRIC实施 和质量改进项目，以测试和实施3个不同的措施集的6项措施。每套 关注儿童护理中的一个重要问题：镰状细胞病，过度使用成像治疗头痛， 癫痫发作和哮喘的门诊治疗总的来说，这些措施提供了巨大的改善潜力， 儿科保健质量。所有这些都是由Q-METRIC团队在最初的儿科 质量衡量计划（PQMP）授予期，使用严格且经过验证的流程。几乎所有这些 已提交并批准纳入国家质量措施信息交换中心的措施 （NQMC），其中一项措施已得到国家质量论坛的认可，并建议纳入 在医疗补助核心措施集。重要的是，选定的措施都是基于索赔的，不需要 成本高且耗时的图表审查;这使得它们更容易实施和使用。Q-METRIC 实施和质量改进小组由儿童健康评估和 密歇根大学的研究单位，2个州医疗补助计划，3个健康计划，3个健康系统，1个 临床联盟和几个国家的领导人在测量和改进，谁填充我们的专家 咨询委员会。为该项目建立的伙伴关系将为该领域带来显著的创新， 传播和实施质量措施，通过（1）我们的能力，创造协同作用， 广泛的方法，分析和测量测试方案，以及（2）开发的机会 多项质量改进（QI）干预措施，在各州、卫生计划和卫生系统中实施 程度.这一方法将侧重于评估这些新技术的可行性和可用性的关键目标， 在确定的三个层面制定了措施。项目工作将围绕以下方面的发展进行组织： 两个队。每个团队将解决FOA中所述的两个关键目标的具体组成部分：团队A：字段 测试、改进、数据收集和报告新措施，B组：使用绩效数据 从定义QI目标和测试多层次改进策略的措施。这两支球队将在 组织起来并行和协同工作以实现项目目标。重点抓好以下 目标：1）继续评估定期业绩评分和可靠性评估， 2）实地测试，以确保卫生计划和卫生部门的科学可接受性; 系统一级，然后评估这些级别的定期绩效评分; 3）探索 规范作为电子措施的可行性。

PROJECT SUMMARY To date, the lack of focus on children in the health care quality movement has been notable. Quality gaps in many areas of pediatric health care delivery have been identified; however, for almost all such conditions, appropriate pediatric quality measures have not been available. In response to the call for proposals for the Cooperative Research Demonstration and Dissemination Projects, we present the Q-METRIC Implementation and Quality Improvement project to test and implement 6 measures in 3 distinct measure sets. Each set is focused on a significant issue in the care of children: sickle cell disease, overuse of imaging for headaches and seizures, and outpatient care of asthma. Collectively, these measures offer great potential for improving pediatric health care quality. All were developed and tested by the Q-METRIC team during the initial Pediatric Quality Measure Program (PQMP) grant period, using a rigorous and validated process. Nearly all of these measures have been submitted and approved for inclusion in the National Quality Measure Clearinghouse (NQMC), and one measure has been endorsed by the National Quality Forum and recommended for inclusion in the Medicaid Core Measure Set. Importantly, the selected measures are all claims-based and do not require costly and time-intensive chart review; this makes them easier to implement and use. The Q-METRIC Implementation and Quality Improvement team consists of investigators from the Child Health Evaluation and Research Unit at the University of Michigan, 2 State Medicaid programs, 3 health plans, 3 health systems, 1 clinical consortium, and several national leaders in measurement and improvement, who populate our expert advisory committees. The partnerships developed for this project will bring remarkable innovation to the dissemination and implementation of the quality measures through (1) our capacity to create synergy across a wide range of methodologic, analytic, and measurement testing scenarios, and (2) the opportunity to develop multiple quality improvement (QI) interventions for implementation across state, health plan, and health system levels. This approach will focus on the key goals of assessing the feasibility and useability of these newly developed measures at the three identified levels. Project efforts will be organized around the development of two teams. Each team will address specific components of the two key goals stated in the FOA: Team A: field testing, refinement, data collection, and reporting on the new measures, and Team B: use of performance data from the measures to define QI goals and test multilevel improvement strategies. These 2 teams will be organized to work both in parallel and in tandem to accomplish project goals. We will focus on the following objectives: 1) continued appraisal of regular performance scores and reliability assessments of these measures, at the state level; 2) field testing to ensure scientific acceptability at the health plan and health system level, followed by appraisal of regular performance scores at these levels; and 3) exploration of the feasibility of specification as e-measures.