Pediatric Quality of Care
The Department houses a leading program regarding measuring and improving the quality of care, with specific focus on maternal-child health care. Faculty members are national leaders in supporting the health care quality agenda of the Centers for Medicare & Medicaid Services and Agency for Healthcare Research and Quality.
Developed by Dr. Larry Kleinman, the Collaboration for Advancing Pediatric Quality Measures (CAPQuaM) is one of seven AHRQ-CMS Centers of Excellence funded by an $8 million AHRQ U-18 cooperative agreement, under the federal Pediatric Quality Measures Program (PQMP). The PQMP is AHRQ's flagship program in children's health and was created by the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009. It's purposes include
- Improve and strengthen...children's health care quality measures;
- Expand on existing pediatric quality measures...and advance [their] development; and
- Increase the portfolio of evidence-based, consensus pediatric quality measures available to public and private purchasers of children's health care services, providers, and consumers.
CAPQuaM is a highly engaged collaboration of national and regional stakeholders that employs its innovative 360 degree measure development process. The 360 degree method systematically integrates literature reviews with stakeholder engagement and expert opinions to develop meaningful quality measures that are practical and grounded in evidence, even when there is residual uncertainty.
CAPQuaM was developed around a number of principles, including:
- It is possible to develop excellent quality measures even when there is meaningful uncertainty about clinical practice
- Medicine is a clinical practice for which the evidence is often not dispositive for a specific patient
- There exist overuse, underuse, and misuse and all should be open to measurement
- Engagement with key stakeholders is central to developing useful and meaningful measures, especially in the context of uncertainty
CAPQuaM's Collaborations and Topic Assignments
Collaboration for Advancing Pediatric Quality Measures' (CAPQuaM) creative approach to developing measures has attracted a national consortium. The CAPQuaM was established with accreditors (The Joint Commission and National Committee on Quality Assurance or NCQA), clinical societies (American Academy of Pediatrics, American Academy of Family Physicians), the New York State Department of Health, including New York State's Medicaid program, the Institute for Patient and Family Centered Care, The National Initiative on Children's Healthcare Quality, Northwestern University, and the Children's and Adolescent Health Measurement Initiative of Oregon Health & Sciences University. As the work of CAPQuaM has become more defined, the American College of Obstetricians and Gynecologists has become an important partner and the Joint Commission has left the consortium. CAPQuaM leadership includes the PI, Dr. Kleinman, and distinguished and pluralistic Steering Committee and Senior Advisory Board.
This broad national team, centered by the CAPQuaM team's work here at the Icahn School of Medicine at Mount Sinai, has been focused on developing an array of measures to respond to the assignments from AHRQ and CMS. CAPQuaM has already submitted for review ten measures:
- Four patient safety measures CAPQuaM regarding inpatient perinatal care and focused on keeping premature babies warm during their initial care in the delivery room and transport to the neonatal care unit
- Two asthma measures that enhance current measures to assess the frequency with which children that are managed for asthma use the emergency department. Additional asthma measures are in development
- Four measures to assess the availability of high risk obstetrical (HROB) services. Additional HROB measures are in development.
- The second round of measure assignments calls for three sets of measures to be developed for 2014:
- Medication reconciliation (general)
- Medication Reconciliation (mental health)
- Follow up after being discharged from a hospital with a mental/behavioral health diagnosis
Scientific leads for the various measures include Dr. Kleinman, Dr. Elizabeth Howell of our Department, Dr. Erin DuPree, CMO of the MSMC and a member of the Department, and Dr. Eyal Shemesh of the Department of Pediatrics.
(CAPQuaM) supports leading national work on the development and dissemination of methods for quality and quality improvement research.
The Program has provided leadership to the first three national conferences regarding Quality Improvement Research Methods directed towards children. The conference is sponsored by the Academic Pediatric Association and is co-located with the Pediatric Academic Societies' annual meeting. Dr. Kleinman has been faculty each year, was PI of the 2012 AHRQ grant that funded the conference, and is course director for CME, sponsored by the Department and the Icahn School of Medicine at Mount Sinai.
A paper that resulted from the first year's conference, coauthored by Dr. Kleinman and Denise Dougherty,4 Senior Advisor, Child Health and Quality Improvement at AHRQ, was recently published as a part of a Pediatrics supplement on Quality and Quality Improvement Research in Children for which Dr. Kleinman was the guest editor.
4Kleinman LC, Dougherty D. Assessing Quality Improvement in Health Care: Theory for Practice. Pediatrics 2013; 131:S110-S119.