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G
Administrative Data
NATIONAL COMMITTEE FOR QUALITY ASSURANCE
(NCQA) MEDICAID HEALTHCARE EFFECTIVENESS DATA
AND INFORMATION SET (HEDIS®) BENCHMARKING
Current Established Child Measures in a Data System That Supports
Benchmarking: 23 HEDIS measures: effectiveness of care (childhood im-
munization status, adolescent immunization status, chlamydia screening
for women, and use of appropriate medications for people with asthma);
accessibility/availability of care (children’s access to primary care practitioners,
annual dental visit), and experience of care (Consumer Assessment of Health-
care Providers and Systems [CAHPS®] 3.0H Child Survey [including screener
for children with chronic conditions and composite measures]).
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: n/a
Age: Measure-specific
289
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290 CHILD AND ADOLESCENT HEALTH
Frequency: Annually—calendar year (continuous enrollment defined differ-
ently for Medicaid than for commercial plans)
Race/Ethnicity: Not reported
Unit Level: Hospital, Physician, Clinic, Managed Care Organization
(MCO), State: MCO
Geography: Most state (state-specific) Medicaid programs use HEDIS
or HEDIS-like specifications (HEDIS specifications but not “continuous
enrollment”)
Use: Improvement/Accountability: Improvement and accountability
Goal: Safety/Well-Being/Permanency: Well-being
Data Source: Administrative data, medical records, or, for the CAHPS®
Limitations: n/a
MEDICARE HOSPITAL COMPARE
Current Established Child Measures in a Data System That Supports Bench-
marking: Medicare Compare: includes children’s asthma process-of-care
measures; however, the numbers are often too small for reliability and/or
public reporting. Three asthma measures: % children who received reliever
medication while hospitalized for asthma, % children received systemic
corticosteroid medication while hospitalized for asthma, and % children
and caregivers who received a home management plan of care. Children’s
hospitals are included in the reports, as well as acute care hospitals.
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: n/a
Age: Measure-specific
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APPENDIX G
Frequency: Annually
Race/Ethnicity: Not reported
Unit Level: Hospital, Physician, Clinic, MCO, State: Provider
Geography: All hospitals within states reporting on Medicare Compare, but
for some measures the numerator/denominator is n/a because of small size
Use: Improvement/Accountability: Improvement and accountability
Goal: Safety/Well-Being/Permanency: Safety and well-being
Data Source: Hospital reporting based on Centers for Medicare and Med-
icaid Services (CMS) specifications. Date—sample of cases.
Limitations: n/a
HEDIS FOR MEDICAID/CHILDREN’S HEALTH
INSURANCE PROGRAM (CHIP)
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: Effectiveness of care (childhood im-
munization status, adolescent immunization status, chlamydia screening
for women, and use of appropriate medications for people with asthma);
accessibility/availability of care (children’s access to primary care practi-
tioners, annual dental visit), and experience of care (CAHPS 3.0H Child
Survey [including screener for children with chronic conditions and com-
posite measures]). Arkansas CHIP MCOs and California and Washington,
DC, Medicaid MCOs submit audited HEDIS and CAHPS data. California
requires CHIP MCOs to be audited. Colorado must submit disenrollment
HEDIS measures. Florida MCOs submit member data for indicators of
access or quality of care. Massachusetts, New Jersey, New York, Utah and
Maryland MCOs report HEDIS data annually to the state. Minnesota, New
Mexico, Pennsylvania, Rhode Island, and Montano require audited HEDIS
data. Ohio requires selected audited HEDIS and HEDIS-like measures, Ten-
nessee MCOs required to report HEDIS in conjunction with their NCQA
accreditation, and Nebraska requires the most recent HEDIS encounter
data.
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292 CHILD AND ADOLESCENT HEALTH
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially be Used for Mea-
surement: n/a
Age: Measure-specific
Frequency: Annually—calendar year (continuous enrollment defined differ-
ently for Medicaid than for commercial plans)
Race/Ethnicity: Not reported
Unit Level: Hospital, Physician, Clinic, MCO, State: Most states Medicaid
MCOs, many states CHIP stand-alone, several states Primary Care Case
Management (PCCM): North Carolina, Massachusetts, Colorado
Geography: Significant subset of states but not all states
Use: Improvement/Accountability: Improvement and accountability
Goal: Safety/Well-Being/Permanency: Well-being
Data Source: Administrative data/claims data (MCOs and PCCMs), medi-
cal records (MCOs), or, for the Consumer Assessment of Health Plans
(CAHPS).
Limitations: n/a
CONSUMER ASSESSMENT OF HEALTH PLANS (CAHPS)
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: MCOs, behavioral health overlays
(BHOs), dental plans, medical groups, physician offices, and clinics. Same
for Medicaid and commercial. Supplemental questions related to child care,
chronic conditions, claims processing, communication, coverage by mul-
tiple plans, dental care, interpreter, Medicaid enrollment, personal doctor,
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APPENDIX G
quality improvement, access to routine care, access to specialist care, after
hours care, calls to personal doctor’s office, coordination of care from other
health providers, customer service, health plan information and materials,
referrals, specialist services, transportation, utilization, and wellness. Two
supplemental surveys are in process of development: health information
technology (HIT) and cultural competency. Users of survey results have ac-
cess to reporting measures as well as guidelines that reflect “best practices”
in reporting.
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: n/a
Age: Adults aged 18 and older and children aged 17 and younger. Patient
completes the adult questionnaire, while patient’s parent or guardian com-
pletes the child questionnaire.
Frequency: Annually
Race/Ethnicity: Can be identified not traditionally reported
Unit Level: Hospital, Physician, Clinic, MCO, State: Depending on survey:
provider, MCO, or state
Geography: Significant subset of states but not all states
Use: Improvement/Accountability: Improvement and accountability
Goal: Safety/Well-Being/Permanency: Safety and well-being
Data Source: Standardized survey tool, but modules vary. CAHPS uses
standardized content, format, protocol for fielding, set of analysis programs
and instructions, and approach to presenting survey results.
Limitations: n/a
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CHILD AND ADOLESCENT HEALTH
MANAGEMENT INITIATIVE (CAHMI)
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: Ambulatory care-sensitive hospital-
ization measures, medical home for children with special heath care needs
(CSHCN), and mental and behavioral quality measures for children and
adolescents. Promoting Healthy Development Survey (PHDS) parent survey
assessing whether young children (3–48 months old) are receiving nation-
ally recommended preventive and developmental services. CSHCN module
is a set of survey-based methods and tools designed to identify children
with special health care needs and measure the basic aspects of health care
quality. CAHMI Young Adult Health Care Survey (YAHCS) measures the
quality of preventive health care provided to adolescents: preventive screen-
ing and counseling on risky behaviors, sexual activity and sexually trans-
mitted diseases (STDs), weight, healthy diet and exercise, and emotional
health and relationship issues; private and confidential care; helpfulness
of counseling; communication and experience of care (derived from draft
Adolescent CAHPS); health information; and global quality measure (teens
received all the components of care measures).
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: n/a
Age: Measure-specific
Frequency: Measure-specific: administered by mail, telephone, online, and
in pediatric offices
Race/Ethnicity: Ability to collect
Unit Level: Hospital, Physician, Clinic, MCO, State: Measure-specific:
provider, system, and state
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APPENDIX G
Geography: To date, more than 45,000 surveys have been collected by
10 Medicaid agencies, four MCOs, 38 pediatric practices, and nationally
through the National Survey of Early Childhood Health (NSECH).
Use: Improvement/Accountability: Improvement and accountability
Goal: Safety/Well-Being/Permanency: Safety and well-being
Data Source: Set of survey-based methods and tools—English and Spanish
Limitations: n/a
MEDICAL HOMES PRACTICE MEASURES
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: Aspects of care measured by Physician
Practice Connections®-Patient-Centered Medical Home™ (PPC-PCMH):
access and communication, patient tracking and registry functions, care
management, patient self-management support, e-prescribing, test and re-
ferral tracking, performance reporting and improvement, and advanced
electronic communications. Medical Home Index (MHI): validated self-
assessment and classification tool designed to rank the level (1–4) of the
practice in six domains (organizational capacity, chronic condition man-
agement, care coordination, community outreach, data management, and
quality improvement and change. Medical Home Family Index (MHFI):
companion survey to be completed by families whose children receive care
from a practice by whom their child has been seen for more than a year.
NCQA has established Physician PPC-PCMH practice measures of perfor-
mance that measure clinical process, clinical outcomes, service data, and
patient safety. For the clinical process and outcome measures, NCQA Dia-
betes Physician Recognition Program (DPRP) or Heart Stroke Recognition
Program (HSRP) measures are used, but the HSRP is not a child measure.
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: n/a
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296 CHILD AND ADOLESCENT HEALTH
Age: Measure-specific
Frequency: Annually—calendar year for HEDIS; year experience for other
Race/Ethnicity: Measure-specific for collection—unknown reporting
Unit Level: Hospital, Physician, Clinic, MCO, State: Provider
Geography: Not necessarily statewide as provider-specific and voluntary.
Pennsylvania Medical Home Project (EPIC IC) has adapted the MHI into
a two-page questionnaire.
Use: Improvement/Accountability: Improvement and accountability
Goal: Safety/Well-Being/Permanency: Safety and well-being
Data Source: Practices seeking PPC-PCMH complete a Web-based data col-
lection tool and provide documentation that validates responses
Limitations: n/a
NATIONAL QUALITY FORUM (NQF)
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: Current pediatric measures: attention-
deficit/hyperactivity disorder (ADHD) diagnosis, management and medi-
cation follow-up; all-cause readmission index; pharyngitis testing; upper
respiratory infection (URI) treatment; asthma assessment, management,
and pharmacologic therapy; body mass index (BMI); CAHPS; central line
catheter infection rate for intensive care unit (ICU) and high-risk nursery
(HRN); immunizations; chlamydia screening; patient fall rate; falls with
injury; hemoglobin A1c; home management plan of care; iatrogenic pneu-
mothorax in non-neonates; tobacco prevention or cessation; serum calcium
and phosphorus concentration; neonate immunization; newborn care (NC)
hours/patient day; pediatric heart surgery mortality and volume; pediatric
patient safety and weight; pediatric intensive care unit (PICU) pain assess-
ment on admission, periodic pain assessment, length of stay (LOS), mortal-
ity ratio, unplanned readmission rate, and Pediatric Quality Indicator (PDI)
11; Promoting Healthy Development Survey (PHDS); ICU in the last 30
days of life; infants screened for retinopathy; skill mix, unlicensed assistive
personnel (UAP); transfusion reaction; ventilator-associated pneumonia for
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APPENDIX G
ICU and HRN; YAHCS. NQF has measures in progress related to ADHD,
asthma, and management of labor.
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: n/a
Age: NQF has numerous quality measures but limited number of pediatric-
specific measures, and the measures that address children are sometimes
included in the numerator and denominator or a larger population; when
they are separated, they are not separated by consistent age breaks as NQF
is guided by evidence-based medicine.
Frequency: Annually
Race/Ethnicity: Sometimes collected but may not be reported
Unit Level: Hospital, Physician, Clinic, MCO, State: Dependent on measure
Geography: Dependent on measure
Use: Improvement/Accountability: Improvement and accountability
Goal: Safety/Well-Being/Permanency: Safety and well-being
Data Source: Dependent on measure
Limitations: n/a
PHYSICIAN QUALITY REPORTING INITIATIVE (PQRI)
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: Of the 175 individual quality mea-
sures and 4 measures in back pain selected for adult PQRI quality measures,
there are a significant number of measures for children or for which chil-
dren are included in the denominator. PQRI measure specifications: title,
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298 CHILD AND ADOLESCENT HEALTH
reporting option (claims or registry), description, frequency, time frames
and applicability, numerator and denominator coding, definitions of terms,
coding instructions, use of Current Procedural Terminology (CPT) Category
II exclusion modifiers and rationale. Specific measures: multiple related to
perioperative care; aspirin for acute myocardial infarction (AMI), multiple
asthma, treatment for URI, appropriate testing for children with pharyngi-
tis, prevention of catheter-related bloodstream infection (CRBSI), multiple
acute otitis externa (AOE), otitis media with effusion (OME) diagnosis
evaluation, breast cancer resection pathology reporting, colorectal cancer
resection, HIT, e-prescribing, melanoma follow-up and coordination of
care, multiple oncology, radiology exposure, dose limits and inappropri-
ate use of “probably benign,” correlation with bone scintigraphy imaging,
multiple HIV, 2 pediatric end stage renal disease (ESRD), 3 referral to
otologic, cancer stage documented, and multiple functional communication
measures.
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: n/a
Age: Measure-specific: some all populations and some children-specific
Frequency: Annually—calendar year
Race/Ethnicity: Unknown
Unit Level: Hospital, Physician, Clinic, MCO, State: Provider
Geography: National: providers directly to CMS
Use: Improvement/Accountability: Accountability
Goal: Safety/Well-Being/Permanency: Well-being
Data Source: Report information to CMS via a claims-based reporting
mechanism (Medicare Part B claims), a registry-based reporting mechanism
(qualified PQRI registry), or a qualified electronic health record submission.
The specifications for the measures provide details for the numerator and
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APPENDIX G
denominator. The denominator population is defined by certain Interna-
tional Classification of Diseases, Ninth Revision, Clinical Modification
(ICD-9-CM) diagnosis, CPT Category I, and Healthcare Common Pro-
cedure Coding System (HCPCS) codes specified in the measure that are
submitted by individual eligible professionals (EPs) as part of a claim for
covered services under the physician fee schedule (PFS).
Limitations: n/a
QUALITY IMPROVEMENT SYSTEM FOR
MANAGED CARE (QISMC)
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures,
Including Established Measures and Indicators: 23 HEDIS measures: effec-
tiveness of care (childhood immunization status, adolescent immunization
status, chlamydia screening for women, and use of appropriate medications
for people with asthma); accessibility/availability of care (children’s access
to primary care practitioners, annual dental visit), and experience of care
(CAHPS® 3.0H Child Survey [including screener for children with chronic
conditions and composite measures]).
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: n/a
Age: Measure-specific
Frequency: Annually—calendar year (continuous enrollment defined differ-
ently for Medicaid than for commercial plans)
Race/Ethnicity: State determined: quality improvement (QI) projects in-
clude breakout by race/ethnicity/special needs
Unit Level: Hospital, Physician, Clinic, MCO, State: MCO
Geography: States that contract with MCOs for Medicaid
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316 CHILD AND ADOLESCENT HEALTH
Frequency: Ongoing
Race/Ethnicity: Unknown
Unit Level: Hospital, Physician, Clinic, MCO, State: n/a
Geography: 10% of the U.S. population
Use: Improvement/Accountability: n/a
Goal: Safety/Well-Being/Permanency: n/a
Data Source: Combined data from the insurance industry and a public
health surveillance system called the immunization information system (IIS)
Limitations: Covered population only
DEPARTMENT OF VETERANS AFFAIRS (VA)
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: VA and U.S. Food and Drug Administration (FDA) effort to
gather and analyze data to gain insight into the effects of the pandemic
vaccine in a primarily elderly, inpatient population. As with other active
surveillance systems, the data generated by this system will be used to detect
the incidence of predefined adverse events of interest.
Age: n/a
Frequency: Unknown
Race/Ethnicity: Unknown
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APPENDIX G
Unit Level: Hospital, Physician, Clinic, MCO, State: n/a
Geography: Approximately 1 million VA patients
Use: Improvement/Accountability: n/a
Goal: Safety/Well-Being/Permanency: n/a
Data Source: Data from the VA health care system have been used in the
past to study incidence rates of adverse events from medications and are
well suited to the task of signal strengthening.
Limitations: Limited to VA population
REAL TIME IMMUNIZATION MONITORING SYSTEM (RTIMS)
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: Automated, Internet-based, passive surveillance system devel-
oped at The Johns Hopkins University to complement the Vaccine Adverse
Event Reporting System (VAERS). This system specifically monitors post-
vaccination outcomes among three of the vaccine priority groups: pregnant
women, health care workers, and school children.
Age: n/a
Frequency: Data entered by vaccines at 1 day, 1 week, and 6 weeks postim-
munization to determine rates of adverse events, which will then be re-
ported to the VAERS.
Race/Ethnicity: Unknown
Unit Level: Hospital, Physician, Clinic, MCO, State: n/a
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318 CHILD AND ADOLESCENT HEALTH
Geography: Unknown
Use: Improvement/Accountability: n/a
Goal: Safety/Well-Being/Permanency: n/a
Data Source: n/a
Limitations: Populations limited to pregnant women, health care workers,
and school children
CLINICAL IMMUNIZATION SAFETY
ASSESSMENT (CISA) NETWORK
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: Six academic medical centers (The Johns Hopkins University,
Boston University, Stanford University, Vanderbilt University, Columbia
University, and Northern California Kaiser Permanente), which as an as-
sociation often collaborate with CDC in efforts to follow-up on serious
VAERS reports, maintain a repository of their findings.
Age: n/a
Frequency: n/a
Race/Ethnicity: Unknown
Unit Level: Hospital, Physician, Clinic, MCO, State: n/a
Geography: Site-specific with CDC
Use: Improvement/Accountability: n/a
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APPENDIX G
Goal: Safety/Well-Being/Permanency: n/a
Data Source: VAERS reports
Limitations: Six academic medical centers
VACCINES AND MEDICATIONS IN PREGNANCY
SURVEILLANCE SYSTEM (VAMPSS)
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: Collaborative effort between the Organization of Teratology
Information Specialists (OTIS), the Slone Epidemiology Center (SEC) at
Boston University, and the American Academy of Allergy, Asthma, and Im-
munology (AAAAI) to collect data on the health effects of pandemic vaccine
administration on maternal and fetal health through case-control studies.
Age: n/a
Frequency: Case study
Race/Ethnicity: Unknown
Unit Level: Hospital, Physician, Clinic, MCO, State: n/a
Geography: Case study site-specific
Use: Improvement/Accountability: n/a
Goal: Safety/Well-Being/Permanency: n/a
Data Source: Data on the health effects of pandemic vaccine administration
on maternal and fetal health through case-control studies
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Limitations: This system is probably not a source of data that are imme-
diately actionable because of the time lag inherent in following groups of
vaccinated and unvaccinated women through their pregnancies.
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
(AHRQ) PATIENT SAFETY INDICATORS (PSI)
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: 20 hospital: anesthesia complications, diagnosis-related group
(DRG) deaths, decubitus ulcer, failure to rescue, foreign body, iatrogenic
pneumothorax, selected infections, multiple postoperative, accidental punc-
ture and laceration, transfusion reaction, birth trauma, and three obstetric
trauma. Seven area-level PSIs: foreign body left, iatrogenic pneumothorax,
selected infections, two postoperative, accidental puncture and laceration,
and transfusion reaction.
Age: Measure-specific
Frequency: Unknown
Race/Ethnicity: Not provided
Unit Level: Hospital, Physician, Clinic, MCO, State: Hospital and regional
Geography: Unknown
Use: Improvement/Accountability: Unknown
Goal: Safety/Well-Being/Permanency: Safety
Data Source: Hospital administrative data using AHRQ software tool
Limitations: Voluntary
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APPENDIX G
HHS UNIVERSAL CLAIMS DATABASE FOR HEALTH RESEARCH
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: Proposed: all-payer, all-claims database
Age: n/a
Frequency: To be determined
Race/Ethnicity: Unknown
Unit Level: Hospital, Physician, Clinic, MCO, State: n/a
Geography: To be determined
Use: Improvement/Accountability: n/a
Goal: Safety/Well-Being/Permanency: n/a
Data Source: Universal database of claims records from all health care
payers, which could be expanded to include other types of health records.
Could broaden the data field against which to conduct comparative effec-
tiveness research and develop children’s quality measures.
Limitations: Does not exist today
STATE-DESIGNED MULTISOURCE, INCLUDING
COMMERCIAL, DATABASES
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
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Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: Multisource data verification and validation services. They com-
bine data contained in a number of public systems, and create a search
function that fits the state’s eligibility process.
Age: Varies by system
Frequency: Unknown
Race/Ethnicity: Unknown
Unit Level: Hospital, Physician, Clinic, MCO, State: Unknown
Geography: State level
Use: Improvement/Accountability: n/a
Goal: Safety/Well-Being/Permanency: n/a
Data Source: Public systems
Limitations: n/a
ASSURING BETTER CHILD HEALTH AND
DEVELOPMENT (ABCD) I, II, III
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
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APPENDIX G
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: Through ABCD II, which began in October 2009, five states
(Arkansas, Illinois, Minnesota, Oklahoma, and Oregon) will develop and
test sustainable models for improving care coordination and linkages be-
tween pediatric primary care providers and other providers who support
children’s healthy development.
Age: Birth to 5 years
Frequency: Unknown
Race/Ethnicity: Unknown
Unit Level: Hospital, Physician, Clinic, MCO, State: Provider
Geography: Within a state—subset of states: Arkansas, Illinois, Minnesota,
Oklahoma, and Oregon
Use: Improvement/Accountability: Improvement and accountability
Goal: Safety/Well-Being/Permanency: Well-being
Data Source: Iowa: identified billing codes that would allow claims data to
identify whether a screening assessment and diagnosis of developmental,
social, and emotional or family risk concerns occurred that could be used
as a data source if the preventive medicine codes were widely used. They
include 99381–99383 for preventive medicine services for new patients for
developmental, social, emotional, and family risk status as part of the com-
prehensive well-child exam. For established patients, 99391–99393, and
for limited developmental testing, 96110. Extended developmental testing,
which would include the Bayley Scales of Infant Development, Woodcock-
Johnson Test of Cognitive Abilities, and Peabody Picture Vocabulary Test,
may also be billed and reported separately or with another code such as
an EandM code.
Limitations: n/a
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CHIP ANNUAL REPORTING TEMPLATE SYSTEM (CARTS)
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: Information: child, family, income, premiums, premium struc-
tures, deductibles, and assets. Seven measures: well-child visits in the first
15 months of life, and 3rd, 4th, 5th, and 6th years of life; use of appropriate
medications for asthma; and access to primary care. Measures based on
HEDIS, but use of HEDIS methodology is not required. State must provide:
measurement specification, population covered, data source, age, whether
there is a continuous enrollment requirement, and type of delivery system.
Age: Reported by age groupings
Frequency: Annually—federal fiscal year (FFY) reported by January 1 of
following year
Race/Ethnicity: Not by measure
Unit Level: Hospital, Physician, Clinic, MCO, State: State
Geography: State
Use: Improvement/Accountability: Improvement and accountability
Goal: Safety/Well-Being/Permanency: n/a
Data Source: Claims, hybrid of claims and medical records, survey, or other
Limitations: State flexibility regarding income standards and eligibility
parameters, such as disregards and small numbers
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APPENDIX G
STATE MEDICAID EFFORTS THAT FOCUSED ON CHILDREN
Current Established Child Measures in a Data System That Supports
Benchmarking: n/a
Current Established Child Measures: n/a
Current Other Measurement Activities Using Various Child Measures, In-
cluding Established Measures and Indicators: n/a
Data/Systems Available: Potential Opportunity to Be a Source for Child
Measures: n/a
Other Activities Producing Data That Could Potentially Be Used for Mea-
surement: Minnesota links birth certificates with Medicaid deliveries in order
to identify Medicaid births. The methodology will be implemented as a data
linkage protocol for Minnesota. Oregon has done preliminary work through
the Public Health Medicaid Assessment Initiative (PHMAI) on the use of
claims data, including encounter data, for public health surveillance. Oregon
has engaged in three processes: developing disease rosters using Medicaid
claims data, collecting survey data, and linking survey and claims data.
Age: Unknown
Frequency: Unknown
Race/Ethnicity: Unknown
Unit Level: Hospital, Physician, Clinic, MCO, State: State
Geography: State-specific
Use: Improvement/Accountability: Eligibility
Goal: Safety/Well-Being/Permanency: n/a
Data Source: Medicaid claims and eligibility; birth records
Limitations: Oregon has identified two data system issues that impact the
feasibility of the use of claims data—the eligibility system and the MCO
enrollment data system. Issues include: standard case definitions are lack-
ing; some case definitions contain criteria; and some case definitions require
variables that are not available for the entire Medicaid population in all
states, such as pharmacy claim information.
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