Developing Measures for Pediatric Quality: Methods and Experiences of the CHIPRA Pediatric Quality Measures Program Grantees

Abstract Background Monitoring quality is an important way of understanding how the health care system is serving children and families. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Pediatric Quality Measures Program (PQMP) funded efforts to develop and enhance measures to assess care for children and adolescents. We describe the processes used by the PQMP grantees to develop measures to assess the health care of children and adolescents in Medicaid and the Children's Health Insurance Program. Methods Key steps in the measures development process include identifying concepts, reviewing and synthesizing evidence, prioritizing concepts, defining how measures should be calculated, and measure testing. Stakeholder engagement throughout the process is critical. Case studies illustrate how PQMP grantees adapted the process to respond to the nature of measures they were charged to develop and overcome challenges encountered. Results PQMP grantees used varied approaches to measures development but faced common challenges, some specific to the field of pediatrics and some general to all quality measures. Major challenges included the limited evidence base, data systems difficult or unsuited for measures reporting, and conflicting stakeholder priorities. Conclusions As part of the PQMP, grantees were able to explore innovative methods to overcome measurement challenges, including new approaches to building the evidence base and stakeholder consensus, integration of alternative data sources, and implementation of new testing methods. As a result, the PQMP has developed new quality measures for pediatric care while also building an infrastructure, expertise, and enhanced methods for measures development that promise to provide more relevant and meaningful tools for improving the quality of children's health care.