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Pediatric HCAHPS Measure Development - Center of Excellence for Pediatric Quality Measurement.pptx

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					Pediatric HCAHPS Measure
Development

Center of Excellence for Pediatric Quality Measurement
                       Agenda
2



AHRQ/CMS Pediatric Quality Measures Program (PQMP)

Overview of Pediatric HCAHPS development process

Opportunities for involvement in Pediatric HCAHPS
 development
Pediatric Quality Measures Program (PQMP)
3



    AHRQ/CMS initiative funded by CHIPRA
      To increase the portfolio of evidence-based, consensus-
       approved pediatric quality measures available to public
       and private purchasers, providers, and consumers

    $55M effort over 4 years (2011-2015)

    7 Centers of Excellence (CoEs) funded across U.S.
    PQMP Measure Development Process
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    Step 1: AHRQ/CMS assigns measures to CoEs


        Step 2: CoEs develop and test measures

            Step 3: CoEs deliver final measures with support materials to
            AHRQ/CMS

                 Step 4: AHRQ/CMS Expert Panel reviews measures

                     Step 5: AHRQ/CMS makes measures available for state
                     Medicaid/CHIP reporting and for general use
    Boston Children’s Hospital Center of Excellence
     for Pediatric Quality Measurement (CEPQM)
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Leadership
     Director: Mark Schuster, MD, PhD
     Interim Managing Director: Sara Toomey, MD, MPH, MPhil,
      MSc
Advisory groups
     Scientific Advisory Board
     National Stakeholder Panel
     Massachusetts Child Health Quality Coalition

Working groups develop and test assigned measures
                  PQMP Assignments
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    42 measures assigned across 7 CoEs
      http://www.ahrq.gov/CHIPRA

    CEPQM round 1 assignments
      Pediatric readmissions
      Inpatient family experience of care (Pediatric HCAHPS)

    CEPQM round 2 assignments
      Transition from child-focused to adult-focused care
      Access to disability support services
      Global tool of patient safety
      Consumer Assessment of Healthcare
       Providers and Systems (CAHPS)
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    Public-private initiative to develop standardized
     surveys of patients’ experiences of care funded by
     AHRQ and CMS
    Gold standard in the field – launched in mid-1990s
    Health care organizations, public and private
     purchasers, consumers, and researchers use CAHPS
     results to:
      Assess the patient-centeredness of care
      Compare and report on performance
      Improve quality of care

                                                          7
            CAHPS Family of Surveys
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    Facility care
      Hospital Survey
      In-Center Hemodialysis Survey
      Nursing Home Surveys (Resident and Family)
    Ambulatory care
      Health Plan Survey*
      Clinician & Group Survey*
      Surgical Care Survey
      ECHO Survey (Behavioral Health)
      Dental Plan Survey
      American Indian Survey
      Home Care Survey
      PCMH Survey*
                                            *Pediatric version available

                                                                           8
    Pediatric HCAHPS Measure Overview
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     CAHPS approach
       Collaborating with the CAHPS team
       Following HCAHPS design principles
       Will be a part of the CAHPS family of measures

     Final measure specification
       Global score with composite measures for each survey
        domain
                           Working Group
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     •   PI: Mark Schuster, MD, PhD (Boston Children’s Hospital)
     •   Patricia Branowicki, MS, RN (Boston Children’s Hospital)
     •   Julie Brown, BA (RAND)*
     •   Paul Cleary, PhD (Yale School of Public Health)*
     •   Marc Elliott, PhD (RAND)*
     •   Jack Fowler, PhD (Univ. Massachusetts Boston)*
     •   Patricia Gallagher, PhD (Univ. Massachusetts Boston)*
     •   Dale Shaller, MPA (Shaller Consulting)*
     •   Susan Shaw, MSN, MS, RN (Boston Children’s Hospital)
     •   Sara Toomey, MD, MPH, MPhil, MSc (Boston Children’s Hospital)
     •   Alan Zaslavsky, PhD (Harvard Medical School)*
         *Member of the CAHPS Consortium


                                                                         10
         CAHPS Survey Design Principles
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     Emphasis on patients
       What patients value
       Aspects of care for which patients are generally the best or
        only source of information
       Extensive testing with patients and families
     Standardization to support valid comparisons and
      benchmarking
       Survey instruments
       Data collection
       Analysis
       Reporting
     All CAHPS surveys and products are in the public domain
                                                                       11
 Pediatric HCAHPS Development Sequence
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     Pre-pilot phase
       Literature and measures review
       Expert interviews
       Federal Register Notice released
       Focus groups in English and Spanish nationally
       Draft candidate items
       Cognitive interviews in English and Spanish nationally
       Finalize draft instrument
     Pilot phase
       National field test (including summer pilot)
       Case-mix adjustment model
       Submission to AHRQ/CMS
                                                                 12
              Respondent Perspective
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     Parent/guardian survey
     Most items reflect parents’ experiences of their
      child’s hospitalization
       During this hospital stay, how often did your child’s
        doctors listen carefully to you?
     A few items reflect parent-report of their child’s
      experience of care during the hospitalization
       During this hospital stay, how often did your child’s
        doctors listen carefully to your child?

                                                                13
               Core HCAHPS Domains
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     Communication with doctors and nurses
     Responsiveness of hospital staff
     Pain management
     Communication about medicines
     Discharge information
     Hospital environment (i.e., cleanliness, quietness)
     Overall hospital rating
     Demographics

                                                            14
                  Expanded Domains
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     Hospital Environment
       Parent accommodations
       Age-appropriate items

     Discharge Process
       Overall organization
       Understanding when to return to activities
       Understanding new medicines



                                                     15
                    New Domains
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     Admission process
     Care coordination
     Family involvement
     Cultural competence
     Child-appropriateness
     Privacy
     Safety
     Adolescent-specific items

                                  16
               Sample New Domains
17



     Admission process
       Admission through the ER
       Kept informed about next steps
       Asked about medications

     Care coordination
       Providers kept up-to-date

     Family involvement
       Value your knowledge as a parent
       Involvement in discussions

                                           17
          Sample New Domains (cont.)
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     Cultural competence
       Discrimination

     Child appropriateness
       Age-appropriate activities available

     Privacy
       Care and/or treatment plan discussions



                                                 18
          Sample New Domains (cont.)
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     Safety
       Medical mistakes

     Adolescent-specific items
       Self-care
       Involvement in discussions




                                       19
                         Next Steps
20




     Pilot phase
       National field test
       Case-mix adjustment model
       Submission to AHRQ/CMS




                                      20
                 National Field Test
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     Field period
       Fall 2012 with 6-9 months data collection

     Recruitment goal
       30-50 hospitals nationwide

     Administration
       CAHPS mail and phone survey protocol
       CAHPS-approved vendors
      National Field Test Eligibility Criteria
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     Age
       Patient < 18yrs AND Parent/Guardian > 18yrs

     Condition
       Ineligible: psychiatric, maternity, healthy newborns

     Length of Stay
       At least one overnight
             National Field Test Timeline
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     National field test (November 2012–Summer 2013)
       National field test (target: 30-50 hospitals)
       Data submission periods in late spring and late summer
       Hospitals may continue using instrument beyond field test period

     Analysis & measure specification (Fall 2013–Winter 2014)
       Psychometric testing, composite analysis
       Case-mix analysis
       Measure specification

     AHRQ Review (Summer 2014 – Fall 2014)
       AHRQ approval as “PQMP” measure
     Benefits of Joining National Field Test
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      Inform Pediatric HCAHPS development

      Initiate Pediatric HCAHPS trend data for your
       hospital

      Contribute to setting national Pediatrics HCAHPS
       benchmarks
           Opportunities to Participate
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     Participate in national field test

     Contact Sara Toomey directly at:
       sara.toomey@childrens.harvard.edu
       857-218-4076
       www.childrenshospital.org/cepqm

				
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