The number of quality measures has grown dramatically in recent years. This growth has outpaced research characterizing content and impact of these metrics. Our study aimed to identify and classify nationally promoted quality metrics applicable to children, both by type and by content, and to analyze the representation of common pediatric issues among available measures.
We identified nationally applicable quality measure collections from organizational databases or clearinghouses, federal Web sites, and key informant interviews and then screened each measure for pediatric applicability. We classified measures as structure, process, or outcome using a Donabedian framework. Additionally, we classified process measures as targeting underuse, overuse, or misuse of health services. We then classified measures by content area and compared disease-specific metrics to frequency of diagnoses observed among children.
A total of 386 identified measures were relevant to pediatric patients; exclusion of duplicates left 257 unique measures. The majority of pediatric measures were process measures (59%), most of which target underuse of health services (77%). Among disease-specific measures, those related to depression and asthma were the most common, reflecting the prevalence and importance of these conditions in pediatrics. Conditions such as respiratory infection and otitis media had fewer associated measures despite their prevalence. Other notable pediatric issues lacking associated measures included care of medically complex children and injuries.
Pediatric quality measures are predominated by process measures targeting underuse of health care services. The content represented among these measures is broad, although there remain important gaps.
We appreciate Dr. Freed and Dr. Dombkowski’s comments about the measures included in our study. For this paper, our focus was on identifying and categorizing broadly used pediatric quality measures with national uptake, with a particular focus on those measure sets required for regulatory or public reporting. We regret that we did not better delineate this focus within the methods section of our manuscript. The landscape of pediatric quality measurement is ever-changing, and there are countless measure sets evolving through various stages of development at any given point in time. To the best of our understanding, the PQMP Centers for Excellence are engaging in iterative work to develop, test, and implement quality measures surrounding topics that are critical to pediatric healthcare. These centers have done excellent work to propose measures that are reliable and valid, and through continued efforts these measures are likely to be implemented and adopted on a broad scale. However, at the time of our data gathering it is our impression that measures from these Centers were still undergoing rigorous review, and had not yet been widely adopted. The work being done at the PQMP Centers for Excellence is critically important to this field, and we look forward to seeing how the rigorous processes utilized at these centers advances quality measurement in the field of pediatrics, in particular, as these measures are integrated into the landscape of publicly reported measures applicable to children. We thank Drs. Freed and Dombkowski for their comments and their very important work in this area.
April 6, 2017
Pediatrics
Letters to the Editor
To the Editors:
We read with interest the recently published manuscript “Categorization of National Pediatric Quality Measures” by House, et al.1
Although the authors reported the methods by which they identified 257 unique quality measures focused on children, we were surprised they did not find several that were contained within the National Quality Measure Clearinghouse (NQMC) maintained by the Agency for Healthcare Research and Quality (AHRQ). Our Center of Excellence in the Pediatric Quality Measures Program had 35 pediatric-specific quality measures accepted into the NQMC and posted on-line by the NQM prior to December 31, 2015. This was the date the authors reported as the last date of searching for inclusion in their results. Of our measures posted by the NQMC, 18 were for the care of children with sickle cell disease, 5 for pediatric sepsis, 5 for follow up of high BMI in the outpatient setting, 2 for the availability of subspecialists and 1 for the overuse of imaging. We were indeed surprised to note that none of our measures appear to be included in the study by House et al.
Given these omissions, we were left wondering whether there might be other measures, posted in national resources for quality measures, similarly not found by the authors and what impact this may have on the results of their study.
Sincerely,
Gary L. Freed, MD, MPH
The Percy and Mary Murphy Professor
of Pediatrics and Child Health Delivery
Child Health Evaluation and Research (CHEAR) Center
Department of Pediatrics and Communicable Diseases
University of Michigan
Kevin J. Dombkowski DrPH, MS
Research Associate Professor
Child Health Evaluation and Research (CHEAR) Center
Department of Pediatrics and Communicable Diseases
University of Michigan
1. House SA, Coon ER, Schroeder AR, Ralston SL. Categorization of National Pediatric Quality Measures. Pediatrics 2017; 139: e20163269