[Federal Register Volume 75, Number 232 (Friday, December 3, 2010)]
[Notices]
[Pages 75469-75471]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-30262]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Priority Setting for the Children's Health Insurance Program
Reauthorization Act (CHIPRA) Pediatric Quality Measures Program
AGENCY: Agency for Healthcare Research and Quality, HHS.
ACTION: Request for public comments.
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SUMMARY: Section 401(a) of the Children's Health Insurance Program
Reauthorization Act of 2009 (Pub. L. 111-3) amended title Xl of the
Social Security Act by inserting after section 1139 the new section
1139A, ``Child Health Quality Measures.'': Subsection 1139A(b),
``Advancing and Improving Pediatric Quality Measures,'' directs the
Secretary to establish a pediatric quality measures program to: improve
and strengthen the initial core child health care quality measures
established by the Secretary under section 1139A(a); expand on existing
pediatric quality measures used by public and private health care
purchasers and advance the development of new quality measures; and
increase the portfolio of evidence-based, consensus pediatric quality
measures available to public and private purchasers of children's
healthcare services, providers, and consumers. Section 1139A(b)(3)
requires the Secretary to consult with a broad range of stakeholders to
set these priorities. To meet the requirement for extensive stakeholder
consultation, we are seeking general public comment on these draft
priorities, and asking the public to identify additional priorities as
needed.
DATES: Comments on this notice must be received by January 14, 2010.
The
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public comment period will close on January 14, 2010 at 5 p.m. EST. Any
comments received after the close of the comment period will not be
considered.
ADDRESSES: You may submit comments by any of the following methods:
1. Electronic Mail_[email protected].
2. Mail--Agency for Healthcare Research and Quality, Attention:
Office of Extramural Research, Education, and Priority Populations-
Public Comment, CHIPRA PQMP Priorities, 540 Gaither Rd., Rockville, MD
20850.
Comments cannot be sent by facsimile transmission, because of staff
and resource limitations. Please note that all submissions may be
posted without change to http://www.AHRQ.gov/chipra, including any
personal information provided.
FOR FURTHER INFORMATION CONTACT:
Denise Dougherty, PhD, Senior Advisor, Child Health and Quality
Improvement, Office of Extramural Research, Education, and Priority
Populations, Agency for Healthcare Research and Quality, 540 Gaither
Rd., Rockville, MD. 301-427-1868. [email protected].
For information regarding this Notice, please contact:
[email protected].
SUPPLEMENTARY INFORMATION: On February 4, 2009, the Congress enacted
the Children's Health Insurance Program Reauthorization Act (CHIPRA) of
2009 (Pub. L. 111-3)., Section 401(a) of the legislation amended title
XI of the Social Security Act (the Act) to establish section 1139A (42
U.S.C. 1320b-9a). Subsection 1139A(b)(E) requires the Secretary to
consult with a wide spectrum of national stakeholders to identify gaps
in existing pediatric quality measures and establish priorities for
development and advancement of such measures. The Secretary delegated
CHIPRA implementation to the Centers for Medicare & Medicaid Services
(CMS). A ``Memorandum of Understanding ``was entered into with the
Agency for Healthcare Research and Quality (AHRQ), by which AHRQ would
conduct several activities in Title IV. These included the
identification of an initial, recommended core set of children's
healthcare quality measures for voluntary use by Medicaid and CHIP
programs and establishment of the Pediatric Quality Measures Program
(PQMP), both in collaboration with CMS.
Pediatric Quality Measures Program (PQMP). The PQMP was required to
be established by January 1, 2011, and authorized to award grants and
contracts. The PQMP will consist of 7-9 cooperative agreement awards to
successful applicants to HS11-001 (http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-11-001.html), and a contract award to a CHIPRA
Coordinating and Technical Assistance Center (http://www.ahrg.gov/chipra/#CTAC), both supervised by AHRQ and CMS. As required by CHIPRA,
successful applicants will work on priorities for measurement methods
and topics set by HHS and informed by the input of multiple
stakeholders.
Multi-stakeholder consultation. Section 1139A(b)(3) requires a
consultation process for establishing priorities for the pediatric
quality measures program that requires consultation with multiple
stakeholders, as follows:
`` * * * the Secretary shall consult with:
``(A) States;
(B) pediatricians, children's hospitals, and other primary and
specialized pediatric health care professionals (including members
of the allied health professions) who specialize in the care and
treatment of children, particularly children with special physical,
mental and developmental health care needs;
(C) dental professionals, including pediatric dental
professionals;
(D) health care providers that furnish primary health care to
children and families who live in urban and rural medically
underserved communities or who are members of distinct population
sub-groups at heightened risk for poor health outcomes;
(E) national organizations representing children, including
children with disabilities and children with chronic conditions;
(F) national organizations representing consumers and purchasers
of children's health care;
(G) national organizations and individuals with expertise in
pediatric health quality measurement; and
(H) voluntary consensus standards setting organizations and
other organizations involved in the advancement of evidence-based
measures of health care.''
Measure topics: Section 1139A(b)(2)(E) requires that the improved
core measure sets include (but not necessarily be limited to) the
following topics and types of healthcare quality measures:
``(A) The duration of children's health insurance coverage over
a 12-month time period.
``(B) The availability and effectiveness of a full range of--
``(i) preventive services, treatments, and services for acute
conditions, including services to promote healthy birth, prevent and
treat premature birth, and detect the presence or risk of physical
or mental conditions that could adversely affect growth and
development; and
``(ii) treatments to correct or ameliorate the effects of
physical and mental conditions, including chronic conditions, in
infants, young children, school-age children, and adolescents.
``(C) The availability of care in a range of ambulatory and
inpatient health care settings in which such care is furnished.
``(D) The types of measures that, taken together, can be used to
estimate the overall national quality of health care for children,
including children with special needs, and to perform comparative
analyses of pediatric health care quality and racial, ethnic, and
socioeconomic disparities in child health and health care for
children.
CHIPRA Section 1139A(b)(2)) requires that the measures developed
under the pediatric quality measures program shall, at a minimum, be:
``(A) evidence-based and, where appropriate, risk adjusted;
``(B) designed to identify and eliminate racial and ethnic
disparities in child health and the provision of health care;
``(C) designed to ensure that the data required for such
measures is collected and reported in a standard format that permits
comparison of quality and data at a State, plan, and provider level;
``(D) periodically updated; and
``(E) responsive to the child health needs, services, and
domains of health care quality described in clauses (i), (ii), and
(iii) of subsection (a)(6)(A).
Definition of healthcare quality measure. For purposes of this
notice, a healthcare quality measure is defined as a mechanism that
enables a user to quantify the quality of a selected aspect of care by
comparing it to a criterion (adapted from http://www.qualitymeasures.AHRQ.gov/resources/measure use.aspx).
Definition of healthcare quality. An Institute of Medicine
Committee on a Future Vision for the National Healthcare Quality and
Disparities Reports has recently updated the IOM recommended framework
for assessing and improving quality so that 6 components of quality
care are identified (safety, timeliness, effectiveness, patient/family-
centeredness, access, efficiency), as well as 2 crosscutting dimensions
(equity and value), three types of care (preventive care, acute
treatment, and chronic condition management), and two additional
elements (care coordination, health systems infrastructure
capabilities). (http://iom.edu/Reports/2010/Future-Directions-for-the-National-Healthcare-Quality-and-Disparities-Reports.aspx). We adopt
this framework for purposes of this public notice.
Prior work to identify priorities for the POMP. The first phase of
CHIPRA required a process for developing recommendations for an initial
core set of quality measures for voluntary use by Medicaid and CHIP
programs. As
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discussed in the Federal Register Notice and background paper that
accompanied the public posting of the initial, recommended core set
(http://www.ahrq.gov/chip/chipraact.htm#Core), not all CHIPRA criteria
were able to be met for the initial core set. Public comments on the
initial, recommended core set, and an expert meeting on measure
criteria for the CHIPRA PQMP (http://www.AHRQ.gov/chipra/#Expert)
provided additional insights into potential priorities for the PQMP.
The combination of these efforts and events led to the identification
of the following potential priorities for measure enhancement and
development of new measures:
1. Development or enhancement of methods to:
a. Standardize measures across all payers, programs, and providers,
public and private, as appropriate, to ensure that comparisons are
valid.
b. Assess disparities in quality by race, ethnicity, socioeconomic
status, geographic region and residence, and special health care needs,
for example by developing new measurement methods or enhancing existing
measurement methods.
c. Adjust for risk by enrollment duration.
d. Stratify or adjust for risk by depth and breadth of coverage.
e. Stratify or adjust for risk by medical conditions, including
severity and acuity.
f. Capitalize on current and coming investments in health
information technology (e.g., patient and procedure registries,
electronic health records, health information exchanges,
interoperability), including meaningful use criteria under the American
Recovery and Reinvestment Act (ARRA).
g. Increase State programs' and CMS's ability to rely on non-
Medicaid and CHIP data sources through improvement in public health
sector measurement (e.g., birth certificate data; immunization
surveys).
h. Come to consensus on the meaning and application of ``evidence-
based'' in the context of healthcare quality measurement for children.
i. Incorporate patient and family perspectives into measurement to
increase understandability.
2. Development or enhancement of measures in key topic areas:
a. Most integrated healthcare settings.
b. Availability of services.
c. Duration of enrollment as a standalone measure.
d. Measures of the content (quality) of care now typically measured
as broad utilization categories (e.g., prenatal, postpartum, newborn
care (including breastfeeding support), well-child and adolescent well-
care visits, screening services, and follow-up visits for chronic
conditions and related medications).
e. Specific care settings and conditions:
i. Perinatal care (e.g., family planning clinics, obstetric and
gynecological care, birth centers).
ii. Quality of mental/behavioral health and substance abuse
services, including prevention and treatment services, across all
settings.
iii. Quality of care in settings beyond traditional medical care
settings (e.g., for screening, diagnostic services and therapies).
iv. Inpatient settings (including specialty inpatient settings).
v. Specialty care for child conditions and diseases.
vi. Care transitions for patients transitioning within and across
health care settings.
vii. Additional measures related to family experiences of care
(e.g., child or adolescent self-reports; perinatal experiences of care;
inpatient experiences)
viii. Health outcome measures (e.g., measures of patient and
population health or other outcomes of healthcare).\2\
ix. Structural measures (e.g., measures of system design features
that are causally linked to improved healthcare processes and
outcomes).
Those submitting comments are encouraged to include a summary of
evidence for the readiness of a topic for quality measurement and the
importance of a topic or method. Additional background information may
be attached. Commenters may wish to address these issues using the
following questions. Commenters may also wish to include in their
comments a summary score based on a scale of 1-5, where 1 is a high
score, 3 is a medium score, and 5 is a low score.
Validity/Underlying Scientific Soundness: To what extent is there a
demonstrated causal relationship between the element of quality to be
measured (as a structure, process, or health outcome of healthcare
delivery) and another element of the healthcare delivery system (e.g.,
structure and process; process and outcome). Commenters may wish to use
as a guide to assessing underlying scientific soundness the method and
criteria used by the AHRQ National Advisory Council Subcommittee on
Children's Healthcare Quality Measures for Medicaid and CHIP, where
appropriate http://www.AHRQ.gov/chipra/corebackground/corebacktab.htm#note5).
Importance: Importance has several dimensions:
To what extent is the topic important to children's health
outcomes, family functioning, or societal functioning, including but
not necessarily limited to high monetary costs of poor quality
healthcare to children, families, or Society?
To what extent is the topic important to reducing
disparities in the quality of care for particular racial and ethnic
groups of children, socioeconomic groups, geographically underserved
groups, and children with special healthcare needs?
To what extent is the topic important as a sentinel
measure that could have spillover effects to the rest of the children's
healthcare delivery system?
To what extent is the proposed methodology important for
addressing current shortcoming of healthcare quality measurement?
We strongly encourage comments to be as succinct as possible (250
words or less per topic, with additional supporting data allowed).
3. Collection of Information Requirements
This voluntary request does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995 (44 U.S.C. 35).
4. Regulatory Impact Analysis
As this notice does not meet the significance criteria of Executive
Order 12866, it was not reviewed by the Office of Management and
Budget.
Dated: November 24, 2010.
Carolyn M. Clancy,
AHRQ Director.
[FR Doc. 2010-30262 Filed 12-2-10; 8:45 am]
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