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.
Improving the quality of care provided to all U.S. children is a national priority. In this proposed project, innovative efforts to (1) disseminate and (2) implement pediatric quality measures will be enhanced through use of quality improvement strategies at the state, health plan and health care system levels. Combined, these two facets of measure development will produce consequential improvements in the quality of care provided to children.