NQF

Agenda Synopsis

Full Agenda

Measure Index

• NQF #1659: Influenza Immunization
• NQF #2842: Family Experiences with Coordination of Care (FECC)-1 Has Care Coordinator
• NQF #2843: Family Experiences with Coordination of Care (FECC) -3: Care coordinator helped to obtain community services
• NQF #2844: Family Experiences with Coordination of Care (FECC) -5: Care coordinator asked about concerns and health
• NQF #2845: Family Experiences with Coordination of Care (FECC) -7: Care coordinator assisted with specialist service referrals
• NQF #2846: Family Experiences with Coordination of Care (FECC)-8: Care coordinator was knowledgeable, supportive and advocated for child’s needs
• NQF #2847: Family Experiences with Coordination of Care (FECC) -9: Appropriate written visit summary content
• NQF #2849: Family Experiences with Coordination of Care (FECC)-15: Caregiver has access to medical interpreter when needed
• NQF #2850: Family Experiences with Coordination of Care (FECC)-16: Child has shared care plan
• NQF #3154: Informed Coverage

• Emergency Department Visits - Potentially Treatable in Primary Care

• NQF #1800: Asthma Medication Ratio (AMR)

• NQF #2800: Metabolic Monitoring for Children and Adolescents on Antipsychotics

• NQF #0480 PC-05 Exclusive Breast Milk Feeding
• NQF #2830 PC-05 Exclusive Breast Milk Feeding
• NQF #2903: Contraceptive Care -- Most and Moderately Effective Methods

• NQF #3166: Antibiotic Prophylaxis for Patients with Sickle Cell Anemia

Full Measure Information

Measure Specifications

• NQF Number (if applicable): 1659
  
  
• Description: Measure Description: Inpatients age 6 months and older discharged during October, November, December, January, February or March who are screened for influenza vaccine status and vaccinated prior to discharge if indicated.
  
  
• Numerator: Numerator Statement: Inpatient discharges who were screened for influenza vaccine status and were vaccinated prior to discharge if indicated.
  
  
• Denominator: Denominator Statement: Acute care hospitalized inpatients age 6 months and older discharged during the months of October, November, December, January, February or March.
  
  
• Exclusions: The following patients are excluded from the denominator: • Patients less than 6 months of age• Patients who expire prior to hospital discharge • Patients with an organ transplant during the current hospitalization (Appendix_A.Table 12.10 Organ Transplant codes.xls) • Patients for whom vaccination was indicated, but supply had not been received by the hospital due to problems with vaccine production or distribution • Patients who have a Length of Stay greater than 120 days • Patients who are transferred or discharged to another acute care hospital • Patients who leave Against Medical Advice (AMA)
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Claims (Only), Other, Paper Records
  
  
• Level of analysis: Facility
  
  
• Care Setting: Hospital
  
  
• Use in Federal Programs: Inpatient Psychiatric Facility Quality Reporting; Hospital Inpatient Quality Reporting
  
  
• Steward: Centers for Medicare and Medicaid Services
  
  
• NQF Staff Notes: Measure Recommended by: Andrea Benin; Gap Areas Addressed: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: No; Immunization coverage was not a gap area identified by the MAP Adult/Child Medicaid 2016 Task Force
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Yes; This is a process measure. This measure is currently in use in: Hospital Compare, Hospital Inpatient Quality Reporting, Hospital Value-Based Purchasing, Inpatient Psychiatric Facility Quality Reporting
  
  
• Does the measure address a quality challenge and or a specific gap area?: No; Evidence for this measure is based on recommendations from the Advisory Committee on Immunization Practices (ACIP) on routine influenza vaccinations. During the 2015-2017 Health and Well-Being project, the Committee acknowledged the importance of this hospital-based measure, but did not believe the narrowing performance gaps were clinically significant (for the 2014-2015 flu season, 10% of hospital cases were not vaccinated).
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is currently in use in: Hospital Compare, Hospital Inpatient Quality Reporting, Hospital Value-Based Purchasing, Inpatient Psychiatric Facility Quality Reporting
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data source(s) for this measure include administrative claims and paper records. As this measure is currently in use, the measure can be feasibly reported. The care setting is the hospital. There is only one version of this measure.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes; This measure was reviewed during the 2015-2017 Health and Well-Being project. This measure received Inactive Endorsement with Reserve Status indicating there is very little opportunity for improvement.
  
  
• Duals sensitive?: No; This measure is focused on individuals 6 months and older, thereby includes children and infants.
  
  
• Both Medicaid Adult and Child sensitive?: Yes; This measure captures inpatients 6 months and older.
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses preventive care in inpatients 6 months and older.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure could decrease the incidence and prevalence of influenza among children.
  
  
• Lead Discussant: Andrea Benin
  
  

Measure Specifications

• NQF Number (if applicable): 2842
  
  
• Description: The Family Experiences with Coordination of Care (FECC) Survey was developed to gather information about the quality of care coordination being received by children with medical complexity (CMC) over the previous 12 months. The FECC Survey is completed by English- and Spanish-speaking caregivers of CMC aged 0-17 years with at least 4 medical visits in the previous year, and it includes all of the information needed to score 20 separate and independent quality measures, a sub-set of 8 of which are included in this submitted measure set. CMC are identified from administrative data using the Pediatric Medical Complexity Algorithm (PMCA)1, which uses up to 3 years’ worth of International Classification of Diseases—9th Revision (ICD-9) codes to classify a child’s illness with regard to chronicity and complexity. CMC are children identified by the PMCA as having complex, chronic disease. The full NQF submission includes a set of 8 of the FECC quality measures; this submission relates to FECC 1, described below. The short descriptions of each quality measure follows; full details of FECC-1 are provided in the Detailed Measure Specifications (see S.2b):2842: FECC-1: Has care coordinator2843: FECC-3: Care coordinator helped to obtain community services2844: FECC-5: Care coordinator asked about concerns and health changes2845: FECC-7: Care coordinator assisted with specialist service referrals2846: FECC-8: Care coordinator was knowledgeable, supportive and advocated for child’s needs2847: FECC-9: Appropriate written visit summary content2849: FECC-15: Caregiver has access to medical interpreter when needed2850: FECC-16: Child has shared care planEach of the quality measures is scored on a 0-100 scale, with higher scores indicating better care. For dichotomous measures, a score of 100 indicates the child received the recommended care; a score of 0 indicates that they did not. Please see Detailed Measure Specifications (see S.2b) for additional measure-specific scoring information.
  
  
• Numerator: The numerator for FECC-1 is specified in the Detailed Measure Specifications (see S.2b). A brief description of each numerator is laid out in Table 1 in section De.3, and a more detailed description of FECC-1 follows:FECC-1: Caregivers of CMC should report that their child has a designated care coordinator.
  
  
• Denominator: The eligible population of caregivers for the FECC Survey overall is composed of those who meet the following criteria:1. Parents or legal guardians of children 0-17 years of age2. Child classified as having a complex, chronic condition using the Pediatric Medical Complexity Algorithm (PMCA) (see Simon TD, Cawthon ML et al. 2014)3. Child had at least 4 visits to a healthcare provider over the previous yearWhile some of the FECC measures only apply to a subset of the overall eligible population for the survey (e.g., measures related to the quality of care coordination services provided are only scored for those caregivers who endorse having a care coordinator), eligibility for these quality measures can only be gleaned from responses to the FECC Survey itself. This is analogous to the situation with many H-CAHPS measures, where, for example, measures about blood draws and laboratory testing are scored only for those who had the relevant service performed during the time frame or hospitalization in question.
  
  
• Exclusions: Denominator exclusions: 1.Child had died2.Caregiver spoke a language other than English or Spanish
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Claims (Only), Patient Reported Data
  
  
• Level of analysis: Health Plan, Population : Regional and State
  
  
• Care Setting: Other
  
  
• Use in Federal Programs: n/a
  
  
• Steward: Seattle Children's Research Institute
  
  
• NQF Staff Notes: Measure Recommended by: Terry Adirim; Gap Areas Addressed: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Care Coordination
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a process measure. The data source is patient reported data. This measure is currently not in use in any federal reporting programs.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Care Coordination The developer provided information on 1 RCT, 1 cohort study, and 5 case series, case control, or historically controlled studies that demonstrated outcomes improve when caregivers of children with medical complexity report their child has a designated care coordinator.During the 2015-16 Pediatric Measures Project, the Committee agreed a gap in care coordination for children with medical complexity exists and there is consensus that this is an important topic to measure, but there are limited data and a lack of consensus on the size of the gap.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is currently not in use in federal reporting programs. However, this measure is currently in use for internal quality improvement by a number of organizations, including children’s hospitals, universities, and health plans.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data source is patient reported data. The Committee noted the data are currently collected via caregiver survey, which is expensive and time-consuming; as a plan-level measure, however, it should be feasible. The level of analysis is health plan and regional/state level. The care setting indicated by the developer is other.There is only one version of this measure
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Duals sensitive?: No; The developer identified the following as the target population: Children, Populations at Risk: Individuals with multiple chronic conditions
  
  
• Both Medicaid Adult and Child sensitive?: No; The population is only children with multiple chronic conditions
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting. Children with medical complexity are a small but high-risk population and care coordination for these children has a significant impact.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Many Medicaid patients are children with special health care needs, including those with medical complexity. This measure could assess that care coordination was available for Medicaid patients; a small but high-risk population wherein care coordination has a significant impact.
  
  
• Lead Discussant: Terry Adirim
  
  

Measure Specifications

• NQF Number (if applicable): 2843
  
  
• Description: The Family Experiences with Coordination of Care (FECC) Survey was developed to gather information about the quality of care coordination being received by children with medical complexity (CMC) over the previous 12 months. The FECC Survey is completed by English- and Spanish-speaking caregivers of CMC aged 0-17 years with at least 4 medical visits in the previous year, and it includes all of the information needed to score 20 separate and independent quality measures, a sub-set of 8 of which are included in this submitted measure set. CMC are identified from administrative data using the Pediatric Medical Complexity Algorithm (PMCA)1, which uses up to 3 years’ worth of International Classification of Diseases—9th Revision (ICD-9) codes to classify a child’s illness with regard to chronicity and complexity. CMC are children identified by the PMCA as having complex, chronic disease. The full NQF submission includes a set of 8 of the FECC quality measures; this submission relates to FECC 3, described below. The short descriptions of each quality measure follows; full details are provided in the Detailed Measure Specifications (see S.2b):2842: FECC-1: Has care coordinator2843: FECC-3: Care coordinator helped to obtain community services2844: FECC-5: Care coordinator asked about concerns and health changes2845: FECC-7: Care coordinator assisted with specialist service referrals2846: FECC-8: Care coordinator was knowledgeable, supportive and advocated for child’s needs2847: FECC-9: Appropriate written visit summary content2849: FECC-15: Caregiver has access to medical interpreter when needed2850: FECC-16: Child has shared care planEach of the quality measures is scored on a 0-100 scale, with higher scores indicating better care. For dichotomous measures, a score of 100 indicates the child received the recommended care; a score of 0 indicates that they did not. Please see Detailed Measure Specifications (see S.2b) for additional measure-specific scoring information.
  
  
• Numerator: The numerators for each of the 10 FECC quality measures included within the FECC measures set are specified in the Detailed Measure Specifications (see S.2b). A brief description of each numerator is laid out in Table 1 in section De.3, and a more detailed description of FECC 3 follows:FECC-3: Caregivers of CMC who report having a designated care coordinator and who require community services should also report that their care coordinator helped their child to obtain needed community services in the last year.
  
  
• Denominator: The eligible population of caregivers for the FECC Survey overall is composed of those who meet the following criteria:1. Parents or legal guardians of children 0-17 years of age2. Child classified as having a complex, chronic condition using the Pediatric Medical Complexity Algorithm (PMCA) (see Simon TD, Cawthon ML et al. 2014)3. Child had at least 4 visits to a healthcare provider over the previous yearWhile some of the FECC measures only apply to a subset of the overall eligible population for the survey (e.g., measures related to the quality of care coordination services provided are only scored for those caregivers who endorse having a care coordinator), eligibility for these quality measures can only be gleaned from responses to the FECC Survey itself. This is analogous to the situation with many H-CAHPS measures, where, for example, measures about blood draws and laboratory testing are scored only for those who had the relevant service performed during the time frame or hospitalization in question.
  
  
• Exclusions: Denominator exclusions: 1.Child had died2.Caregiver spoke a language other than English or Spanish
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Claims (Only), Patient Reported Data
  
  
• Level of analysis: Health Plan, Population : Regional and State
  
  
• Care Setting: Other
  
  
• Use in Federal Programs: n/a
  
  
• Steward: Seattle Children's Research Institute
  
  
• NQF Staff Notes: Measure Recommended by: Terry Adirim; Gap Areas Addressed: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Care Coordination
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a process measure. The data source is patient reported data. This measure is currently not in use in any federal reporting programs.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Care Coordination The developer provided information on 1 RCT, 1 cohort study, and 5 case series, case control, or historically controlled studies that demonstrated outcomes improve when caregivers of children with medical complexity report their child has a designated care coordinator.During the 2015-16 Pediatric Measures Project, the Committee agreed a gap in care coordination for children with medical complexity exists and there is consensus that this is an important topic to measure, but there are limited data and a lack of consensus on the size of the gap.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is currently not in use in federal reporting programs. However, this measure is currently in use for internal quality improvement by a number of organizations, including children’s hospitals, universities, and health plans.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data source is patient reported data.The Committee noted the data are currently collected via caregiver survey, which is expensive and time-consuming; as a plan-level measure, however, it should be feasible. The level of analysis is the at the health plan and regional/state level. The care setting indicated by the developer is Other.There is only one version of this measure
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Duals sensitive?: No; The developer identified the following as the target population: Children, Populations at Risk: Individuals with multiple chronic conditions
  
  
• Both Medicaid Adult and Child sensitive?: No; The population is only children with multiple chronic conditions
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting. Children with medical complexity are a small but high-risk population and care coordination for these children has a significant impact.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Many Medicaid patients are children with special health care needs, including those with medical complexity. This measure could assess the ability of care coordinators to link patients to available community services.
  
  
• Lead Discussant: Terry Adirim
  
  

Measure Specifications

• NQF Number (if applicable): 2844
  
  
• Description: The Family Experiences with Coordination of Care (FECC) Survey was developed to gather information about the quality of care coordination being received by children with medical complexity (CMC) over the previous 12 months. The FECC Survey is completed by English- and Spanish-speaking caregivers of CMC aged 0-17 years with at least 4 medical visits in the previous year, and it includes all of the information needed to score 20 separate and independent quality measures, a sub-set of 8 of which are included in this submitted measure set. CMC are identified from administrative data using the Pediatric Medical Complexity Algorithm (PMCA)1, which uses up to 3 years’ worth of International Classification of Diseases—9th Revision (ICD-9) codes to classify a child’s illness with regard to chronicity and complexity. CMC are children identified by the PMCA as having complex, chronic disease. The full NQF submission includes a set of 8 of the FECC quality measures; this submission relates to FECC 5, described below. The short descriptions of each quality measure follows; full details are provided in the Detailed Measure Specifications (see S.2b):2842: FECC-1: Has care coordinator2843: FECC-3: Care coordinator helped to obtain community services2844: FECC-5: Care coordinator asked about concerns and health changes2845: FECC-7: Care coordinator assisted with specialist service referrals2846: FECC-8: Care coordinator was knowledgeable, supportive and advocated for child’s needs2847: FECC-9: Appropriate written visit summary content2849: FECC-15: Caregiver has access to medical interpreter when needed2850: FECC-16: Child has shared care planEach of the quality measures is scored on a 0-100 scale, with higher scores indicating better care. For dichotomous measures, a score of 100 indicates the child received the recommended care; a score of 0 indicates that they did not. Please see Detailed Measure Specifications (see S.2b) for additional measure-specific scoring information.
  
  
• Numerator: The numerator for FECC-5 is specified in the Detailed Measure Specifications (see S.2b). A brief description of each numerator is laid out in Table 1 in section De.3, and a more detailed description follows:FECC-5:Caregivers of CMC who report having a care coordinator and who report that their care coordinator has contacted them in the last 3 months should also report that their care coordinator asked them about the following:•Caregiver concerns•Health changes of the child
  
  
• Denominator: The eligible population of caregivers for the FECC Survey overall is composed of those who meet the following criteria:1. Parents or legal guardians of children 0-17 years of age2. Child classified as having a complex, chronic condition using the Pediatric Medical Complexity Algorithm (PMCA) (see Simon TD, Cawthon ML et al. 2014)3. Child had at least 4 visits to a healthcare provider over the previous yearWhile some of the FECC measures only apply to a subset of the overall eligible population for the survey (e.g., measures related to the quality of care coordination services provided are only scored for those caregivers who endorse having a care coordinator), eligibility for these quality measures can only be gleaned from responses to the FECC Survey itself. This is analogous to the situation with many H-CAHPS measures, where, for example, measures about blood draws and laboratory testing are scored only for those who had the relevant service performed during the time frame or hospitalization in question.
  
  
• Exclusions: Denominator exclusions: 1.Child had died2.Caregiver spoke a language other than English or Spanish
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Claims (Only), Patient Reported Data
  
  
• Level of analysis: Health Plan, Population : Regional and State
  
  
• Care Setting: Other
  
  
• Use in Federal Programs: n/a
  
  
• Steward: Seattle Children's Research Institute
  
  
• NQF Staff Notes: Measure Recommended by: Terry Adirim; Gap Areas Addressed: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Care Coordination
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a process measure. The data source is patient reported data. This measure is currently not in use in any federal reporting programs.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Care Coordination The developer provided information on 1 RCT, 1 cohort study, and 5 case series, case control, or historically controlled studies that demonstrated outcomes improve when caregivers of children with medical complexity report their child has a designated care coordinator.During the 2015-16 Pediatric Measures Project, the Committee agreed a gap in care coordination for children with medical complexity exists and there is consensus that this is an important topic to measure, but there are limited data and a lack of consensus on the size of the gap.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is currently not in use in federal reporting programs. However, this measure is currently in use for internal quality improvement by a number of organizations, including children’s hospitals, universities, and health plans.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data source is patient reported data.The Committee noted the data are currently collected via caregiver survey, which is expensive and time-consuming; as a plan-level measure, however, it should be feasible. The level of analysis is the at the health plan and regional/state level. The care setting indicated by the developer is Other. There is only one version of this measure
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Duals sensitive?: No; The developer identified the following as the target population: Children, Populations at Risk: Individuals with multiple chronic conditions
  
  
• Both Medicaid Adult and Child sensitive?: No; The population is only children with multiple chronic conditions
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting. Children with medical complexity are a small but high-risk population and care coordination for these children has a significant impact.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Many Medicaid patients are children with special health care needs, including those with medical complexity. This measure could assess the ability of care coordinators to discover related issues that could be affecting the patient’s health.
  
  
• Lead Discussant: Terry Adirim
  
  

Measure Specifications

• NQF Number (if applicable): 2845
  
  
• Description: The Family Experiences with Coordination of Care (FECC) Survey was developed to gather information about the quality of care coordination being received by children with medical complexity (CMC) over the previous 12 months. The FECC Survey is completed by English- and Spanish-speaking caregivers of CMC aged 0-17 years with at least 4 medical visits in the previous year, and it includes all of the information needed to score 20 separate and independent quality measures, a sub-set of 8 of which are included in this submitted measure set. CMC are identified from administrative data using the Pediatric Medical Complexity Algorithm (PMCA)1, which uses up to 3 years’ worth of International Classification of Diseases—9th Revision (ICD-9) codes to classify a child’s illness with regard to chronicity and complexity. CMC are children identified by the PMCA as having complex, chronic disease. The full NQF submission includes a set of 8 of the FECC quality measures; this submission relates to FECC 7, described below. The short descriptions of each quality measure follows; full details are provided in the Detailed Measure Specifications (see S.2b):2842: FECC-1: Has care coordinator2843: FECC-3: Care coordinator helped to obtain community services2844: FECC-5: Care coordinator asked about concerns and health changes2845: FECC-7: Care coordinator assisted with specialist service referrals2846: FECC-8: Care coordinator was knowledgeable, supportive and advocated for child’s needs2847: FECC-9: Appropriate written visit summary content2849: FECC-15: Caregiver has access to medical interpreter when needed2850: FECC-16: Child has shared care planEach of the quality measures is scored on a 0-100 scale, with higher scores indicating better care. For dichotomous measures, a score of 100 indicates the child received the recommended care; a score of 0 indicates that they did not. Please see Detailed Measure Specifications (see S.2b) for additional measure-specific scoring information.
  
  
• Numerator: The numerator for FECC-7 is specified in the Detailed Measure Specifications (see S.2b). A brief description of each numerator is laid out in Table 1 in section De.3, and a more detailed description of FECC-7 follows:FECC-7: Caregivers of CMC who report having a care coordinator for their child should also report that the care coordinator assists them with specialty service referrals by ensuring that the appointment with the specialty service provider occurs
  
  
• Denominator: The eligible population of caregivers for the FECC Survey overall is composed of those who meet the following criteria:1. Parents or legal guardians of children 0-17 years of age2. Child classified as having a complex, chronic condition using the Pediatric Medical Complexity Algorithm (PMCA) (see Simon TD, Cawthon ML et al. 2014)3. Child had at least 4 visits to a healthcare provider over the previous yearWhile some of the FECC measures only apply to a subset of the overall eligible population for the survey (e.g., measures related to the quality of care coordination services provided are only scored for those caregivers who endorse having a care coordinator), eligibility for these quality measures can only be gleaned from responses to the FECC Survey itself. This is analogous to the situation with many H-CAHPS measures, where, for example, measures about blood draws and laboratory testing are scored only for those who had the relevant service performed during the time frame or hospitalization in question.
  
  
• Exclusions: Denominator exclusions: 1.Child had died2.Caregiver spoke a language other than English or Spanish
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Claims (Only), Patient Reported Data
  
  
• Level of analysis: Health Plan, Population : Regional and State
  
  
• Care Setting: Other
  
  
• Use in Federal Programs: n/a
  
  
• Steward: Seattle Children's Research Institute
  
  
• NQF Staff Notes: Measure Recommended by: Terry Adirim; Gap Areas Addressed: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Care Coordination
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a process measure. The data source is patient reported. This measure is currently not in use in any federal reporting programs.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Care Coordination The developer provided information on 1 RCT, 1 cohort study, and 5 case series, case control, or historically controlled studies that demonstrated outcomes improve when caregivers of children with medical complexity report their child has a designated care coordinator.During the 2015-16 Pediatric Measures Project, the Committee agreed a gap in care coordination for children with medical complexity exists and there is consensus that this is an important topic to measure, but there are limited data and a lack of consensus on the size of the gap.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is currently not in use in federal reporting programs. However, this measure is currently in use for internal quality improvement by a number of organizations, including children’s hospitals, universities, and health plans.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data source is patient reported data.The Committee noted the data are currently collected via caregiver survey, which is expensive and time-consuming; as a plan-level measure, however, it should be feasible. The level of analysis is the at the health plan and regional/state level. The care setting indicated by the developer is Other.There is only one version of this measure
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Duals sensitive?: No; The developer identified the following as the target population: Children, Populations at Risk: Individuals with multiple chronic conditions
  
  
• Both Medicaid Adult and Child sensitive?: No; The population is only caregivers of children with medical complexity children with multiple chronic conditions
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting. Children with medical complexity are a small but high-risk population and care coordination for these children has a significant impact.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Many Medicaid patients are children with special health care needs, including those with medical complexity. This measure could assess the ability of care coordinators to assist with referrals.
  
  
• Lead Discussant: Terry Adirim
  
  

Measure Specifications

• NQF Number (if applicable): 2846
  
  
• Description: The Family Experiences with Coordination of Care (FECC) Survey was developed to gather information about the quality of care coordination being received by children with medical complexity (CMC) over the previous 12 months. The FECC Survey is completed by English- and Spanish-speaking caregivers of CMC aged 0-17 years with at least 4 medical visits in the previous year, and it includes all of the information needed to score 20 separate and independent quality measures, a sub-set of 8 of which are included in this submitted measure set. CMC are identified from administrative data using the Pediatric Medical Complexity Algorithm (PMCA)1, which uses up to 3 years’ worth of International Classification of Diseases—9th Revision (ICD-9) codes to classify a child’s illness with regard to chronicity and complexity. CMC are children identified by the PMCA as having complex, chronic disease. The full NQF submission includes a set of 8 of the FECC quality measures; this submission relates to FECC 8, described below. The short descriptions of each quality measure follows; full details for FECC-8 are provided in the Detailed Measure Specifications (see S.2b):2842: FECC-1: Has care coordinator2843: FECC-3: Care coordinator helped to obtain community services2844: FECC-5: Care coordinator asked about concerns and health changes2845: FECC-7: Care coordinator assisted with specialist service referrals2846: FECC-8: Care coordinator was knowledgeable, supportive and advocated for child’s needs2847: FECC-9: Appropriate written visit summary content2849: FECC-15: Caregiver has access to medical interpreter when needed2850: FECC-16: Child has shared care planEach of the quality measures is scored on a 0-100 scale, with higher scores indicating better care. For dichotomous measures, a score of 100 indicates the child received the recommended care; a score of 0 indicates that they did not. Please see Detailed Measure Specifications (see S.2b) for additional measure-specific scoring information.
  
  
• Numerator: The numerator for FECC-8 is specified in the Detailed Measure Specifications (see S.2b). A brief description of each numerator is laid out in Table 1 in section De.3, and a more detailed description of FECC-8 follows:FECC-8: Caregivers of CMC who report having a care coordinator should also report that their care coordinator: •Was knowledgeable about their child’s health•Supported the caregiver•Advocated for the needs of the child
  
  
• Denominator: The eligible population of caregivers for the FECC Survey overall is composed of those who meet the following criteria:1. Parents or legal guardians of children 0-17 years of age2. Child classified as having a complex, chronic condition using the Pediatric Medical Complexity Algorithm (PMCA) (see Simon TD, Cawthon ML et al. 2014)3. Child had at least 4 visits to a healthcare provider over the previous yearWhile some of the FECC measures only apply to a subset of the overall eligible population for the survey (e.g., measures related to the quality of care coordination services provided are only scored for those caregivers who endorse having a care coordinator), eligibility for these quality measures can only be gleaned from responses to the FECC Survey itself. This is analogous to the situation with many H-CAHPS measures, where, for example, measures about blood draws and laboratory testing are scored only for those who had the relevant service performed during the time frame or hospitalization in question.
  
  
• Exclusions: Denominator exclusions: 1.Child had died2.Caregiver spoke a language other than English or Spanish
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Claims (Only), Patient Reported Data
  
  
• Level of analysis: Health Plan, Population : Regional and State
  
  
• Care Setting: Other
  
  
• Use in Federal Programs: n/a
  
  
• Steward: Seattle Children's Research Institute
  
  
• NQF Staff Notes: Measure Recommended by: Terry Adirim; Gap Areas Addressed: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Care Coordination
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a process measure. The data source is patient reported data. This measure is currently not in use in any federal reporting programs.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Care Coordination The developer provided information on 1 RCT, 1 cohort study, and 5 case series, case control, or historically controlled studies that demonstrated outcomes improve when caregivers of children with medical complexity report their child has a designated care coordinator.During the 2015-16 Pediatric Measures Project, the Committee agreed a gap in care coordination for children with medical complexity exists and there is consensus that this is an important topic to measure, but there are limited data and a lack of consensus on the size of the gap.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is currently not in use in federal reporting programs. However, this measure is currently in use for internal quality improvement by a number of organizations, including children’s hospitals, universities, and health plans.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data source is patient reported data.The Committee noted the data are currently collected via caregiver survey, which is expensive and time-consuming; as a plan-level measure, however, it should be feasible. The level of analysis is the at the health plan and regional/state level. The care setting indicated by the developer is Other.There is only one version of this measure
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Duals sensitive?: No; The developer identified the following as the target population: Children, Populations at Risk: Individuals with multiple chronic conditions
  
  
• Both Medicaid Adult and Child sensitive?: No; The population is only children with multiple chronic conditions
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting. Children with medical complexity are a small but high-risk population and care coordination for these children has a significant impact.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Many Medicaid patients are children with special health care needs, including those with medical complexity. This measure could assess the experiences of the family regarding the care coordinator.
  
  
• Lead Discussant: Terry Adirim
  
  

Measure Specifications

• NQF Number (if applicable): 2847
  
  
• Description: The Family Experiences with Coordination of Care (FECC) Survey was developed to gather information about the quality of care coordination being received by children with medical complexity (CMC) over the previous 12 months. The FECC Survey is completed by English- and Spanish-speaking caregivers of CMC aged 0-17 years with at least 4 medical visits in the previous year, and it includes all of the information needed to score 20 separate and independent quality measures, a sub-set of 8 of which are included in this submitted measure set. CMC are identified from administrative data using the Pediatric Medical Complexity Algorithm (PMCA)1, which uses up to 3 years’ worth of International Classification of Diseases—9th Revision (ICD-9) codes to classify a child’s illness with regard to chronicity and complexity. CMC are children identified by the PMCA as having complex, chronic disease. The full NQF submission includes a set of 8 of the FECC quality measures; this submission relates to FECC 9, described below. The short descriptions of each quality measure follows; full details for FECC-9 are provided in the Detailed Measure Specifications (see S.2b):2842: FECC-1: Has care coordinator2843: FECC-3: Care coordinator helped to obtain community services2844: FECC-5: Care coordinator asked about concerns and health changes2845: FECC-7: Care coordinator assisted with specialist service referrals2846: FECC-8: Care coordinator was knowledgeable, supportive and advocated for child’s needs2847: FECC-9: Appropriate written visit summary content2849: FECC-15: Caregiver has access to medical interpreter when needed2850: FECC-16: Child has shared care planEach of the quality measures is scored on a 0-100 scale, with higher scores indicating better care. For dichotomous measures, a score of 100 indicates the child received the recommended care; a score of 0 indicates that they did not. Please see Detailed Measure Specifications (see S.2b) for additional measure-specific scoring information.
  
  
• Numerator: The numerator for FECC-9 is specified in the Detailed Measure Specifications (see S.2b). A brief description of each numerator is laid out in Table 1 in section De.3, and a more detailed description of FECC-9 follows:FECC-9: Caregivers of CMC who report receiving a written visit summary during the last 12 months from their child’s main provider’s office should report that it contained the following elements:•Current problem list•Current medication list•Drug allergies•Specialists involved in the child’s care•Planned follow-up•What to do for problems related to outpatient visit
  
  
• Denominator: The eligible population of caregivers for the FECC Survey overall is composed of those who meet the following criteria:1. Parents or legal guardians of children 0-17 years of age2. Child classified as having a complex, chronic condition using the Pediatric Medical Complexity Algorithm (PMCA) (see Simon TD, Cawthon ML et al. 2014)3. Child had at least 4 visits to a healthcare provider over the previous yearWhile some of the FECC measures only apply to a subset of the overall eligible population for the survey (e.g., measures related to the quality of care coordination services provided are only scored for those caregivers who endorse having a care coordinator), eligibility for these quality measures can only be gleaned from responses to the FECC Survey itself. This is analogous to the situation with many H-CAHPS measures, where, for example, measures about blood draws and laboratory testing are scored only for those who had the relevant service performed during the time frame or hospitalization in question.
  
  
• Exclusions: Denominator exclusions: 1.Child had died2.Caregiver spoke a language other than English or Spanish
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Claims (Only), Patient Reported Data
  
  
• Level of analysis: Health Plan, Population : Regional and State
  
  
• Care Setting: Other
  
  
• Use in Federal Programs: n/a
  
  
• Steward: Seattle Children's Research Institute
  
  
• NQF Staff Notes: Measure Recommended by: Terry Adirim; Gap Areas Addressed: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Care Coordination
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a process measure. The data source is patient reported data. This measure is currently not in use in any federal reporting programs.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Care Coordination The developer provided information on 1 RCT, 1 cohort study, and 5 case series, case control, or historically controlled studies that demonstrated outcomes improve when caregivers of children with medical complexity report their child has a designated care coordinator.During the 2015-16 Pediatric Measures Project, the Committee agreed a gap in care coordination for children with medical complexity exists and there is consensus that this is an important topic to measure, but there are limited data and a lack of consensus on the size of the gap.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is currently not in use in federal reporting programs. However, this measure is currently in use for internal quality improvement by a number of organizations, including children’s hospitals, universities, and health plans.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data source is patient reported data.The Committee noted the data are currently collected via caregiver survey, which is expensive and time-consuming; as a plan-level measure, however, it should be feasible. The level of analysis is the at the health plan and regional/state level. The care setting indicated by the developer is Other.There is only one version of this measure
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Duals sensitive?: No; The developer identified the following as the target population: Children, Populations at Risk: Individuals with multiple chronic conditions
  
  
• Both Medicaid Adult and Child sensitive?: No; The population is only children with multiple chronic conditions
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting. Children with medical complexity are a small but high-risk population and care coordination for these children has a significant impact.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Many Medicaid patients are children with special health care needs, including those with medical complexity. This measure could assess the correct and appropriate information was recorded.
  
  
• Lead Discussant: Terry Adirim
  
  

Measure Specifications

• NQF Number (if applicable): 2849
  
  
• Description: The Family Experiences with Coordination of Care (FECC) Survey was developed to gather information about the quality of care coordination being received by children with medical complexity (CMC) over the previous 12 months. The FECC Survey is completed by English- and Spanish-speaking caregivers of CMC aged 0-17 years with at least 4 medical visits in the previous year, and it includes all of the information needed to score 20 separate and independent quality measures, a sub-set of 8 of which are included in this submitted measure set. CMC are identified from administrative data using the Pediatric Medical Complexity Algorithm (PMCA)1, which uses up to 3 years’ worth of International Classification of Diseases—9th Revision (ICD-9) codes to classify a child’s illness with regard to chronicity and complexity. CMC are children identified by the PMCA as having complex, chronic disease. The full NQF submission includes a set of 8 of the FECC quality measures; this submission relates to FECC 15, described below. The short descriptions of each quality measure follows; full details for FECC-15 are provided in the Detailed Measure Specifications (see S.2b):2842: FECC-1: Has care coordinator2843: FECC-3: Care coordinator helped to obtain community services2844: FECC-5: Care coordinator asked about concerns and health changes2845: FECC-7: Care coordinator assisted with specialist service referrals2846: FECC-8: Care coordinator was knowledgeable, supportive and advocated for child’s needs2847: FECC-9: Appropriate written visit summary content2849: FECC-15: Caregiver has access to medical interpreter when needed2850: FECC-16: Child has shared care planEach of the quality measures is scored on a 0-100 scale, with higher scores indicating better care. For dichotomous measures, a score of 100 indicates the child received the recommended care; a score of 0 indicates that they did not. Please see Detailed Measure Specifications (see S.2b) for additional measure-specific scoring information.
  
  
• Numerator: The numerator for FECC-15 is specified in the Detailed Measure Specifications (see S.2b). A brief description of each numerator is laid out in Table 1 in section De.3, and a more detailed description of FECC-15 follows:FECC-15: Caregivers of CMC who self-identify as having a preference for conducting medical visits in a language other than English should have access to a professional medical interpreter (live or telephonic) at all visits for which an interpreter is needed.
  
  
• Denominator: The eligible population of caregivers for the FECC Survey overall is composed of those who meet the following criteria:1. Parents or legal guardians of children 0-17 years of age2. Child classified as having a complex, chronic condition using the Pediatric Medical Complexity Algorithm (PMCA) (see Simon TD, Cawthon ML et al. 2014)3. Child had at least 4 visits to a healthcare provider over the previous yearWhile some of the FECC measures only apply to a subset of the overall eligible population for the survey (e.g., measures related to the quality of care coordination services provided are only scored for those caregivers who endorse having a care coordinator), eligibility for these quality measures can only be gleaned from responses to the FECC Survey itself. This is analogous to the situation with many H-CAHPS measures, where, for example, measures about blood draws and laboratory testing are scored only for those who had the relevant service performed during the time frame or hospitalization in question.
  
  
• Exclusions: Denominator exclusions: 1.Child had died2.Caregiver spoke a language other than English or Spanish
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Claims (Only), Patient Reported Data
  
  
• Level of analysis: Health Plan, Population : Regional and State
  
  
• Care Setting: Other
  
  
• Use in Federal Programs: n/a
  
  
• Steward: Seattle Children's Research Institute
  
  
• NQF Staff Notes: Measure Recommended by: Terry Adirim; Gap Areas Addressed: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Care Coordination
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a process measure. The data source is patient reported data. This measure is currently not in use in any federal reporting programs.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Care Coordination The developer provided information on 1 RCT, 1 cohort study, and 5 case series, case control, or historically controlled studies that demonstrated outcomes improve when caregivers of children with medical complexity report their child has a designated care coordinator.During the 2015-16 Pediatric Measures Project, the Committee agreed a gap in care coordination for children with medical complexity exists and there is consensus that this is an important topic to measure, but there are limited data and a lack of consensus on the size of the gap.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is currently not in use in federal reporting programs. However, this measure is currently in use for internal quality improvement by a number of organizations, including children’s hospitals, universities, and health plans.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data source is patient reported data.The Committee noted the data are currently collected via caregiver survey, which is expensive and time-consuming; as a plan-level measure, however, it should be feasible. The level of analysis is the at the health plan and regional/state level. The care setting indicated by the developer is Other.There is only one version of this measure
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Duals sensitive?: No; The developer identified the following as the target population: Children, Populations at Risk: Individuals with multiple chronic conditions
  
  
• Both Medicaid Adult and Child sensitive?: No; The population is only children with multiple chronic conditions
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting. Children with medical complexity are a small but high-risk population and care coordination for these children has a significant impact.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure could assess the prevalence of available interpreters for caregivers.
  
  
• Lead Discussant: Terry Adirim
  
  

Measure Specifications

• NQF Number (if applicable): 2850
  
  
• Description: The Family Experiences with Coordination of Care (FECC) Survey was developed to gather information about the quality of care coordination being received by children with medical complexity (CMC) over the previous 12 months. The FECC Survey is completed by English- and Spanish-speaking caregivers of CMC aged 0-17 years with at least 4 medical visits in the previous year, and it includes all of the information needed to score 20 separate and independent quality measures, a sub-set of 8 of which are included in this submitted measure set. CMC are identified from administrative data using the Pediatric Medical Complexity Algorithm (PMCA)1, which uses up to 3 years’ worth of International Classification of Diseases—9th Revision (ICD-9) codes to classify a child’s illness with regard to chronicity and complexity. CMC are children identified by the PMCA as having complex, chronic disease. The full NQF submission includes a set of 8 of the FECC quality measures; this submission relates to FECC 16, described below. The short descriptions of each quality measure follows; full details for FECC-16 are provided in the Detailed Measure Specifications (see S.2b):2842: FECC-1: Has care coordinator2843: FECC-3: Care coordinator helped to obtain community services2844: FECC-5: Care coordinator asked about concerns and health changes2845: FECC-7: Care coordinator assisted with specialist service referrals2846: FECC-8: Care coordinator was knowledgeable, supportive and advocated for child’s needs2847: FECC-9: Appropriate written visit summary content2849: FECC-15: Caregiver has access to medical interpreter when needed2850: FECC-16: Child has shared care planEach of the quality measures is scored on a 0-100 scale, with higher scores indicating better care. For dichotomous measures, a score of 100 indicates the child received the recommended care; a score of 0 indicates that they did not. Please see Detailed Measure Specifications (see S.2b) for additional measure-specific scoring information.
  
  
• Numerator: The numerator for FECC-16 is specified in the Detailed Measure Specifications (see S.2b). A brief description of each numerator is laid out in Table 1 in section De.3, and a more detailed description of FECC-16 follows:FECC-16: Caregivers of CMC should report that their child’s primary care provider created a shared care plan for their child.
  
  
• Denominator: The eligible population of caregivers for the FECC Survey overall is composed of those who meet the following criteria:1. Parents or legal guardians of children 0-17 years of age2. Child classified as having a complex, chronic condition using the Pediatric Medical Complexity Algorithm (PMCA) (see Simon TD, Cawthon ML et al. 2014)3. Child had at least 4 visits to a healthcare provider over the previous yearWhile some of the FECC measures only apply to a subset of the overall eligible population for the survey (e.g., measures related to the quality of care coordination services provided are only scored for those caregivers who endorse having a care coordinator), eligibility for these quality measures can only be gleaned from responses to the FECC Survey itself. This is analogous to the situation with many H-CAHPS measures, where, for example, measures about blood draws and laboratory testing are scored only for those who had the relevant service performed during the time frame or hospitalization in question.
  
  
• Exclusions: Denominator exclusions: 1.Child had died2.Caregiver spoke a language other than English or Spanish
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Claims (Only), Patient Reported Data
  
  
• Level of analysis: Health Plan, Population : Regional and State
  
  
• Care Setting: Other
  
  
• Use in Federal Programs: n/a
  
  
• Steward: Seattle Children's Research Institute
  
  
• NQF Staff Notes: Measure Recommended by: Terry Adirim; Gap Areas Addressed: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Care Coordination
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a process measure. The data source is patient reported data. This measure is currently not in use in any federal reporting programs.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Care Coordination The developer provided information on 1 RCT, 1 cohort study, and 5 case series, case control, or historically controlled studies that demonstrated outcomes improve when caregivers of children with medical complexity report their child has a designated care coordinator.During the 2015-16 Pediatric Measures Project, the Committee agreed a gap in care coordination for children with medical complexity exists and there is consensus that this is an important topic to measure, but there are limited data and a lack of consensus on the size of the gap.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is currently not in use in federal reporting programs. However, this measure is currently in use for internal quality improvement by a number of organizations, including children’s hospitals, universities, and health plans.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data source is patient reported data.The Committee noted the data are currently collected via caregiver survey, which is expensive and time-consuming; as a plan-level measure, however, it should be feasible. The level of analysis is the at the health plan and regional/state level. The care setting indicated by the developer is Other.There is only one version of this measure
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Duals sensitive?: No; The developer identified the following as the target population: Children, Populations at Risk: Individuals with multiple chronic conditions
  
  
• Both Medicaid Adult and Child sensitive?: No; The population is only children with multiple chronic conditions
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting. Children with medical complexity are a small but high-risk population and care coordination for these children has a significant impact.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Many Medicaid patients are children with special health care needs, including those with medical complexity. This measure could assess shared communication and coordination among the care team.
  
  
• Lead Discussant: Terry Adirim
  
  

Measure Specifications

• NQF Number (if applicable): 3154
  
  
• Description: Brief Description of Measure: Improved measurement of the continuity of insurance coverage in the Medicaid and CHIP population is needed to help maximize insurance continuity and coverage for vulnerable children. To further this goal, the AHRQ-CMS CHIPRA PQMP Center of Excellence at the Children’s Hospital of Philadelphia developed the metric Informed Coverage. The metric is designed to more accurately measure coverage among children enrolled in Medicaid or CHIP at the state level and overcome the current inability in the Medicaid Analytic eXtract (MAX) dataset to determine whether a child disenrolled from Medicaid and CHIP due to loss of eligibility (such as due to parental income increase or the acquisition of employer-sponsored insurance, a “good” reason) or failure to appropriately re-enroll (a “bad” reason). This measure can help federal and state programs develop strategies to retain children eligible for coverage and minimize gaps that can occur during the renewal process. Informed Coverage assesses the continuity of enrollment of children in publicly financed insurance programs (Medicaid and CHIP), as defined by the ratio of enrolled month to eligible months over an 18 month observation window. Informed Coverage uses a natural experiment based on the random event of appendicitis to “inform” the estimate of coverage in a given state, bounded by two extreme assumptions regarding unknown eligibility
  
  
• Numerator: Numerator Statement: The numerator for Informed Coverage represents the sum (within a state) of months enrolled in Medicaid/CHIP for all children over an 18-month window.
  
  
• Denominator: Denominator Statement: The sum (within a state) of months eligible for Medicaid/CHIP for all children (0-18 years) over an 18-month window. In addition, months that could be defined as “eligible” are based on known events recorded in the MAX data that would affect eligibility (birth or ageing out).
  
  
• Exclusions: For the appendicitis calculation, the population is limited to children between the ages of 2 to 16 years old. To determine what is the best assumption to use (either the Appendectomy Coverage Rate (or ACR), PI, or PE) inside each state, we compare the observed appendectomy coverage rate in a state, to the estimated coverage rate that would be calculated in that state with either PI, or PE assumptions.
  
  
• Endorsement Status: New Measure
  
  
• Endorsement Status Notes: Public and Member Comment (Pediatric Performance Measures Phase 2)
  
  
• Measure Type: Outcome
  
  
• Data Source: Claims (Only)
  
  
• Level of analysis: Population : Regional and State
  
  
• Care Setting: No Applicable Care Setting
  
  
• Use in Federal Programs: n/a
  
  
• Steward: The Children's Hospital of Philadelphia
  
  
• NQF Staff Notes: Measure Recommended by: Andrea Benin; Gap Areas Addressed: Care coordination; Duration of children's health insurance coverage over a 12-month period; New measure included under Pediatric Performance Measures Phase 2 project. During the March 2 in-person meeting, the meeting could not reach a consensus on this measure.
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap areas: Care Coordination and duration of children’s health insurance coverage over a 12-month period
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a new outcome measure. The data source is claims data. This measure is not currently used in federal reporting programs.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap areas: Care Coordination and duration of children’s health insurance coverage over a 12-month period. The developer cites that continuity of insurance coverage has the potential to impact child and adolescent health in a number of ways. First, continuous coverage without gaps can permit children and adolescents access to a regular source of care and therefore reduce unmet needs.There is evidence that variation exists in continuous enrollment for 43 states, and that disparities occur among different racial and ethnic groups.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is designed to capture all children enrolled in Medicaid or CHIP at the state level. Committee members viewed this measure as valuable for internal purposes and for measuring the quality of coordination in maintaining enrollment.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The Committee expressed concern about whether states could accurately calculate the measure, given the complicated nature of the specifications. In addition, Committee members noted that the database used for the measure, the MAX database, has its own data issues. However, the Committee did view this measure as valuable. The level of analysis is at the regional and state level. The data source is claims data. The developer did not indicate an applicable care setting. There is only one format of this measure. The 2016 Child Task Force discussed this measure. Only one Task Force member motioned to vote on the measure for inclusion into the Core Set; two members are needed to vote on the measure for a motion to pass.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes; This measure has been submitted for NQF endorsement. This measure is included under the Pediatric Performance Measures Phase 2 project. During the in-person meeting, the Committee could not reach a consensus on this measure. This measure will be discussed on the post-comment call on May 31, 2017. The measure will be finalized in June.
  
  
• Duals sensitive?: No; This measure is designed to only capture children enrolled in Medicaid or CHIP at the state level.
  
  
• Both Medicaid Adult and Child sensitive?: No; This measure is designed to only capture children enrolled in Medicaid or CHIP at the state level.
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure could provide enhanced prevalence data on insurance coverage among children enrolled in Medicaid and CHIP.
  
  
• Lead Discussant: Andrea Benin
  
  

Measure Specifications

• NQF Number (if applicable): N/A
  
  
• Description: Ambulatory emergency department visits for conditions potentially treatable in primary care per 1,000 member months by age group.
  
  
• Numerator: Count of ambulatory emergency department visits by members for conditions potentially treatable in primary care, during the measurement period, for the eligible population, based on the most current HEDIS specification for Ambulatory Care (AMB) - ED visits definition (Procedure Codes: 99281, 99282, 99283, 99284, 99285 OR Revenue Codes: 0450, 0451, 0452, 0456, 0459, 0981; Claim Type: Outpatient, Outpatient Crossover); Age groups are 0-17 years, 18-64 years, and 65+ years of age
  
  
• Denominator: Total member months for each age group breakout. oMember months are a count of how many months each member is in the managed care program.oContinuous enrollment is not a requirement. Therefore a member who is enrolled for a full quarter will add 3 member months to the total; while a member who is in the program for 1 month of a quarter will add only 1 month to the total.oAge determined at the end of each month.oCount members enrolled for a partial month as being enrolled for one month.
  
  
• Exclusions: None
  
  
• Endorsement Status: Not Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Cost and Resource Use
  
  
• Data Source: Administrative claims
  
  
• Level of analysis: Health Plan; to be discussed
  
  
• Care Setting: Emergency Medical Services/Ambulance
  
  
• Use in Federal Programs: n/a
  
  
• Steward: New Hampshire DHHS
  
  
• NQF Staff Notes: Measure Recommended by: Richard Antonelli; Gap Areas Addressed: Cost measures
  
  

Summary of NQF Endorsement Review

• QPS Link: N/A
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Cost Measures
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a cost and resource use measure. The data source is claims data. This measure is not currently used in a federal reporting program.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Cost Measures
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is currently in use in New Hampshire to monitor their managed care organizations and will also utilize it with their delivery system reform incentive program (DSRIP) waiver.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The level of analysis is at the health plan level. It reports utilization of services based on administrative data (claims and encounters).There is only one version of the measure.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: No; This measure is not NQF endorsed nor has it been submitted for endorsement
  
  
• Duals sensitive?: Yes; The population encompasses all ages who have an emergency department visit
  
  
• Both Medicaid Adult and Child sensitive?: Yes; The population encompasses all ages who have an emergency department visit
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure affects a critical sub-population of Medicaid beneficiaries who have complex care needs and high costs.
  
  
• Lead Discussant: Richard Antonelli
  
  

Measure Specifications

• NQF Number (if applicable): 1800
  
  
• Description: The percentage of members 5–64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year
  
  
• Numerator: The number of members who have a medication ratio of at least 0.50
  
  
• Denominator: All health plan members 5–64 years of age during the measurement year who were identified as having moderate to severe persistent asthma
  
  
• Exclusions: 1)Exclude any members who had at least one encounter, in any setting, with any code to identify a diagnosis of emphysema, COPD, cystic fibrosis or acute respiratory failure (Table ASM-E). Look as far back as possible in the member’s history through December 31 of the measurement year.2)Exclude any members who have no medication events present in their record during the measurement year.
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Administrative claims
  
  
• Level of analysis: Health Plan, Integrated Delivery System
  
  
• Care Setting: Clinician Office/Clinic
  
  
• Use in Federal Programs: n/a
  
  
• Steward: NCQA
  
  
• NQF Staff Notes: Measure Recommended by: Terry Adirim; Gap Areas Addressed: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Asthma. Although, asthma was not listed as a gap area during the 2016 meeting. Measure #1799, currently on the Core Set lost endorsement during the 2015-2016 maintenance review. Endorsement was removed for #1799 Medication Management for people with Asthma currently on the Child Core Set because the Pulmonary and Critical Care Standing Committee could not reach consensus. Specifically, the Committee noted concern over the evidence (especially with the Yoon et al study noting inaccuracies in the data analysis) as well as with the long list of allowable medications. They pointed out that the measure does not address whether patients are getting the correct medications for their particular type of asthma. The CSAC then reviewed the measure and did not reach the 60% pass rate in order to approve this measure for endorsement; thus, the measure lost its endorsement.
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Yes; This is a process measure. The data source is administrative claims. This measure is publically reported both nationally and by geographic regions in NCQA’s State of Health Care annual report, in Consumer Reports and the NCQA website. This measure is used to calculate NCQA’s health plan ratings and in scoring for accreditation of Medicare Advantage Health Plans. This measure is also used in Quality Compass, a tool used for selecting a health plan, conducting competitor analysis, examining quality improvement and benchmarking plan performance.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Asthma. The measure’s evidence is derived from the 2007 guidelines for the diagnosis and management of asthma from the National Heart and Lung and Blood Institutes (NHLBI) of the National Institutes of Health (NIH).Gaps in measure performance have been consistent throughout 2012, 2013, and 2014; The measure showed slight improvement across Medicaid health plans (~2 percentage points).However, there is no information on performance data stratified by race, ethnicity, or language.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; This measure is publically reported both nationally and by geographic regions in NCQA’s State of Health Care annual report. This measure is used in Quality Compass, a tool used for selecting a health plan, conducting competitor analysis, examining quality improvement and benchmarking plan performance.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The level of analysis is the health plan, the care setting is at the clinician office/clinic and the data source is administrative claims. The Pulmonary Standing Committee agreed the measure is feasible. All data are generated during care processes and are currently included in defined fields in electronic claims.There is only one version of the measure. This measure was discussed by the 2016 Task Force. This measure was brought forward from a public comment for #1799 indicating that #1800 is better. The 2016 Adult Task Force voted to recommend #1799, but there was no motion to vote on #1800. There did not seem to be any discussion regarding this measure from the Child Task Force in 2016.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Duals sensitive?: No; The population covers only those 5-64 years of age with asthma
  
  
• Both Medicaid Adult and Child sensitive?: Yes; The population covers all individuals between 5-64 years of age with asthma
  
  
• Summary: What is the potential value to the program measure set?: The measure could potentially replace the only asthma measure currently on the Child Core Set. It is likely CMS will not keep a measure that lost endorsement on the Core Set.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure provides enhanced prevalence data on patients identified as having persistent asthma and whose controller medications made up at least half of their total asthma medications.
  
  
• Lead Discussant: Terry Adirim
  
  

Measure Specifications

• NQF Number (if applicable): 2800
  
  
• Description: The percentage of children and adolescents 1-17 years of age who had two or more antipsychotic prescriptions and had metabolic testing.
  
  
• Numerator: Children and adolescents who received glucose and cholesterol tests during the measurement year.
  
  
• Denominator: Children and adolescents who had ongoing use of antipsychotic medication (at least two prescriptions).
  
  
• Exclusions: No exclusions
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Claims (Only)
  
  
• Level of analysis: Health Plan, Integrated Delivery System, Population : Regional and State
  
  
• Care Setting: Clinician Office/Clinic, Laboratory, Behavioral Health : Outpatient
  
  
• Use in Federal Programs: n/a
  
  
• Steward: NCQA
  
  
• NQF Staff Notes: Measure Recommended by: Kim Elliott and Richard Antonelli; Gap Areas Addressed: Mental Health
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Mental Health
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Yes; This is a process measure. The data source is administrative claims. The level of analysis is at the health plan, integrated delivery system and state level. The measure is a part of HEDIS. The measure is included in Quality Compass for Medicaid 2015, a tool that displays health plan-level performance rates for HEDIS measures. It is used for selecting a health plan, conducting competitor analysis, examining quality improvement and benchmarking plan performance. The measure also is reported on in The State of Health Care Quality Report, a national report produced by the developer including the results from HEDIS measures.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Mental Health.The measure is based on 11 evidence-based clinical practice guidelines and standards from 5 organizations, particularly the guidelines from the American Academy of Child and Adolescent Psychiatry (AACAP).The Committee noted the low rate of measure performance among children receiving metabolic screening after a new antipsychotic medication prescription (6% based on MAX data), indicating there is a performance gap.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; The measure is a part of HEDIS. The measure is included in Quality Compass for Medicaid 2015, a tool that displays health plan-level performance rates for HEDIS measures. It is used for selecting a health plan, conducting competitor analysis, examining quality improvement and benchmarking plan performance. The measure also is reported on in The State of Health Care Quality Report, a national report produced by the developer including the results from HEDIS measures.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The measure data elements are all generated through normal process of care, and are in defined fields in electronic claims. The care settings indicated are: Behavioral Health: Outpatient, Clinician Office/Clinic, Laboratory. The Committee noted the measure is feasible for collection by health plans and states using administrative claims data. There is only one version of this measure.This measure was discussed by the 2016 Child Task Force. No Task Force member motioned to vote on the measure for inclusion into the Core Set.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Duals sensitive?: No; The population only covers children and adolescents 1-17 years of age
  
  
• Both Medicaid Adult and Child sensitive?: No; The population only covers children and adolescents 1-17 years of age
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure could help to identify and address serious side effects associated with antipsychotic medication use among children and adolescents.
  
  
• Lead Discussant: Kim Elliot and Richard Antonelli
  
  

Measure Specifications

• NQF Number (if applicable): 0480
  
  
• Description: PC-05 assesses the number of newborns exclusively fed breast milk during the newborn's entire hospitalization. This measure is a part of a set of five nationally implemented measures that address perinatal care (PC-01: Elective Delivery, PC-02: Cesarean Birth, PC-03: Antenatal Steroids, PC-04: Health Care-Associated Bloodstream Infections in Newborns).
  
  
• Numerator: Newborns that were fed breast milk only since birth
  
  
• Denominator: Single term liveborn newborns discharged alive from the hospital with ICD-10-CM Principal Diagnosis Code for single liveborn newborn as defined in Appendix A, Table 11.20.1 available at: http://manual.jointcommission.org/releases/TJC2016A/
  
  
• Exclusions: Admitted to the Neonatal Intensive Care Unit (NICU) at this hospital during the hospitalization • ICD-10-CM Other Diagnosis Codes for galactosemia as defined in Appendix A, Table 11.21 • ICD-10-PCS Principal Procedure Code or ICD-10-PCS Other Procedure Codes for parenteral infusion as defined in Appendix A, Table 11.22 • Experienced death • Length of Stay >120 days • Patients transferred to another hospital • Patients who are not term or with < 37 weeks gestation completed
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Electronic Health Record (Only), Paper Records
  
  
• Level of analysis: Facility, Other
  
  
• Care Setting: Hospital
  
  
• Use in Federal Programs: EHR Incentive ProgramCore Quality Measures Collaborative Ob-Gyn Core Set (CMS-AHIP)Also, as noted, in The Joint Commission's Perinatal Care Core Set and collected for all hospitals with 300 or more births/year for The Joint Commission accreditation process
  
  
• Steward: The Joint Commission
  
  
• NQF Staff Notes: Measure Recommended by: Carol Sakala; Gap Areas Addressed: Care coordination; Overuse/medically unnecessary care; Note from submitter: NQF #3041 combines identically specified previously separate paper/0480 and electronic/2830 measures. Last year's Perinatal and Reproductive Health Standing Committee supported continued endorsement of 0480 and endorsement of the newly available eCQM 2830.
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap areas: Perinatal Care. This was not identified as a gap in 2016. However, perinatal care will always an important part of any Medicaid discussion since a significant portion of the Medicaid population is in their child-bearing years.
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Yes; This is a process measure. The level of analysis indicated is facility and other. The paper-based measure is currently in use in The Joint Commission’s: Quality Check; Hospital Accreditation Program; Annual Report, and Perinatal Care Certification. The e-measure is currently in use in The Joint Commission’s: Hospital Inpatient Quality Reporting Program, Hospital Accreditation Program and EHR Incentive Program.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; Although not a gap identified in 2016, this measure addresses perinatal care. The developer cites numerous RCTs conducted over the past decades demonstrating improved health benefits of breast-feeding for both mother and newborn. Some of the improved health benefits for newborns include risk reductions of otitis media, respiratory tract infections, type 2 diabetes, and obesity.Data reported to The Joint Commission demonstrated wide variation in performance and, in over half the hospitals reporting, rates have not yet reached 50 percent.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; The paper-based measure is currently in use in The Joint Commission’s: Quality Check; Hospital Accreditation Program; Annual Report, and Perinatal Care Certification. The e-measure is currently in use in The Joint Commission’s: Hospital Inpatient Quality Reporting Program, Hospital Accreditation Program and EHR Incentive Program. Six healthcare organizations reported the eMeasure to The Joint Commission in 2015 and 31 healthcare organizations will be reporting the eMeasure in 2016.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data source is electronic health records and paper records. The level of analysis indicated is facility and other. The care setting is the hospital. There is limited use of the e-measure thus far and the Perinatal and Reproductive Health Committee found it difficult to comment on feasibility. However, the Committee thought the usability of the eMeasure would be similar to the medical record abstraction measure. The paper-based measure is collected via manual review and its use is widespread; the measure can be feasibly reported. There is the paper and e-measure format. Both formats are NQF Endorsed. The paper version (#0480) was recommended for inclusion in 2014 and 2015. Both formats (#0480 and #2830) were recommended for inclusion by the 2016 Child Task Force. CMS did not include either format into the 2017 Child Core Set.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes; Both formats of this measure are NQF endorsed
  
  
• Duals sensitive?: No; The population encompasses only newborns.
  
  
• Both Medicaid Adult and Child sensitive?: No; The population encompasses only newborns.
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a potential benefit for both mother and child as well as a measure deemed important by past Task Forces.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure provides enhanced prevalence data on the number of newborns exclusively fed breastmilk during their entire hospital stay.
  
  
• Lead Discussant: Carol Sakala
  
  

Measure Specifications

• NQF Number (if applicable): 2830
  
  
• Description: PC-05 assesses the number of newborns exclusively fed breast milk during the newborn's entire hospitalization. This measure is a part of a set of five nationally implemented measures that address perinatal care (PC-01: Elective Delivery, PC-02: Cesarean Section, PC-03: Antenatal Steroids, PC-04: Health Care-Associated Bloodstream Infections in Newborns). PC-05, Exclusive Breast Milk Feeding, is one of two measures in this set that have been reengineered as eCQMs and are included in the EHR Incentive Program and Hospital Inpatient Quality Reporting Program.
  
  
• Numerator: Newborns that were fed breast milk only since birth
  
  
• Denominator: Single term newborns discharged from the hospital who did not have a diagnosis of galactosemia, were not subject to parenteral nutrition, and had a length of stay of less than or equal to 120 days
  
  
• Exclusions: Newborns who were admitted to the Neonatal Intensive Care Unit (NICU)-Newborns who were transferred to an acute care facility-Newborns who expired during the hospitalization
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Process
  
  
• Data Source: Electronic Health Record (Only), Other
  
  
• Level of analysis: Facility, Other
  
  
• Care Setting: Hospital
  
  
• Use in Federal Programs: EHR Incentive ProgramCore Quality Measures Collaborative Ob-Gyn Core Set (CMS-AHIP)Also, as noted, in The Joint Commission's Perinatal Care Core Set and collected for all hospitals with 300 or more births/year for The Joint Commission accreditation process
  
  
• Steward: The Joint Commission
  
  
• NQF Staff Notes: Measure Recommended by: Carol Sakala; Gap Areas Addressed: Care coordination; Overuse/medically unnecessary care; Note from submitter: NQF #3041 combines identically specified previously separate paper/0480 and electronic/2830 measures. Last year's Perinatal and Reproductive Health Standing Committee supported continued endorsement of 0480 and endorsement of the newly available eCQM 2830.
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap areas: Perinatal Care. This was not identified as a gap in 2016. However, perinatal care will always an important part of any Medicaid discussion since a significant portion of the Medicaid population is in their child-bearing years.
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Yes; This is a process measure. The level of analysis indicated is facility and other. The paper-based measure is currently in use in The Joint Commission’s: Quality Check; Hospital Accreditation Program; Annual Report, and Perinatal Care Certification. The e-measure is currently in use in The Joint Commission’s: Hospital Inpatient Quality Reporting Program, Hospital Accreditation Program and EHR Incentive Program.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; Although not a gap identified in 2016, this measure addresses perinatal care. The developer cites numerous RCTs conducted over the past decades demonstrating improved health benefits of breast-feeding for both mother and newborn. Some of the improved health benefits for newborns include risk reductions of otitis media, respiratory tract infections, type 2 diabetes, and obesity.Data reported to The Joint Commission demonstrated wide variation in performance and, in over half the hospitals reporting, rates have not yet reached 50 percent.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; The paper-based measure is currently in use in The Joint Commission’s: Quality Check; Hospital Accreditation Program; Annual Report, and Perinatal Care Certification. The e-measure is currently in use in The Joint Commission’s: Hospital Inpatient Quality Reporting Program, Hospital Accreditation Program and EHR Incentive Program. Six healthcare organizations reported the eMeasure to The Joint Commission in 2015 and 31 healthcare organizations will be reporting the eMeasure in 2016.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data source is electronic health records and paper records. The level of analysis indicated is facility and other. The care setting is the hospital. There is limited use of the e-measure thus far and the Perinatal and Reproductive Health Committee found it difficult to comment on feasibility. However, the Committee thought the usability of the eMeasure would be similar to the medical record abstraction measure. The paper-based measure is collected via manual review and its use is widespread; the measure can be feasibly reported. There is the paper and e-measure format. Both formats are NQF Endorsed. The paper version (#0480) was recommended for inclusion in 2014 and 2015. Both formats (#0480 and #2830) were recommended for inclusion by the 2016 Child Task Force. CMS did not include either format into the 2017 Child Core Set.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes; Both formats of this measure are NQF endorsed
  
  
• Duals sensitive?: No; The population encompasses only newborns.
  
  
• Both Medicaid Adult and Child sensitive?: No; The population encompasses only newborns.
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a potential benefit for both mother and child as well as a measure deemed important by past Task Forces.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure provides enhanced prevalence data on the number of newborns exclusively fed breastmilk during their entire hospital stay.
  
  
• Lead Discussant: Carol Sakala
  
  

Measure Specifications

• NQF Number (if applicable): 2903
  
  
• Description: The percentage of women aged 15-44 years at risk of unintended pregnancy that is provided a most effective (i.e., sterilization, implants, intrauterine devices or systems (IUD/IUS)) or moderately effective (i.e., injectables, oral pills, patch, ring, or diaphragm) FDA-approved method of contraception.The proposed measure is an intermediate outcome measure because it represents a decision that is made at the end of a clinical encounter about the type of contraceptive method a woman will use, and because of the strong association between type of contraceptive method used and risk of unintended pregnancy.
  
  
• Numerator: Women aged 15-44 years of age at risk of unintended pregnancy who are provided a most (sterilization, intrauterine device, implant) or moderately (pill, patch, ring, injectable, diaphragm) effective method of contraception.
  
  
• Denominator: Women aged 15-44 years of age who are at risk of unintended pregnancy.
  
  
• Exclusions: The following categories of women are excluded from the denominator: (1) those who are infecund for non-contraceptive reasons; (2) those who had a live birth in the last 2 months of the measurement year; or (3) those who were still pregnant or their pregnancy outcome was unknown at the end of the year.
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Intermediate Outcome
  
  
• Data Source: Administrative claims
  
  
• Level of analysis: Facility; Health Plan; Population : Regional; Population : State
  
  
• Care Setting: The primary audience for the measure is primary care providers and providers of dedicated family planning services. However, consistent with the QFP recommendations, the measures could be used by any provider interested in contraceptive access"
  
  
• Use in Federal Programs: CMCS’ Maternal and Infant Health initiative has funded 14 state Medicaid programs to report on the measure through 2018. For more information, see https://www.medicaid.gov/medicaid/quality-of-care/improvement-initiatives/maternal-and-infant-health/data-and-measurement/index.htmlLink for ASTHO work reported below under 'currently being used" question: http://www.astho.org/Programs/Maternal-and-Child-Health/Increasing-Access-to-Contraception/Link for Title X program reported below under "currently being used" question: http://www.fpntc.org/using-the-contraceptive-care-measures-in-the-title-x-programAlso since space is limited below, clarifying that OPA is working with NACHC to develop eMeasure version to make collection easier in FQHCsThis is also closely aligned with and complementary to #2902 Contraceptive Care -- Postpartum, a new addition to both the Medicaid Child and Adult Core Sets, stratified by age.
  
  
• Steward: U.S. Office of Population Affairs
  
  
• NQF Staff Notes: Measure Recommended by: Carol Sakala; Gap Areas Addressed: Overuse/medically unnecessary care
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap area: Maternal Health. Note: not a gap identified by task force in 2016.
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Yes; This is an intermediate outcome measure. The data source is administrative claims. The measure has been extensively piloted by two state Medicaid programs and is being reported by 13 state Medicaid programs. The measures are being reported from 2015 to 2018 as part of the Maternal and Infant Health initiative.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap area: Maternal Health; NOTE: not identified as a gap in 2016The developers provided clinical guidelines as evidence for this measure (CDC/OPA (2014); ACOG and AAP (2014)).The percentage of women of reproductive age who are at risk of unintended pregnancy is 38 million and 51% of 6.7 million pregnancies each year are unintended. Additionally, there are gaps in unintended pregnancy, especially for teens and unmarried women.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; The measure has been extensively piloted by two state Medicaid programs and is being reported by 13 state Medicaid programs. The measures are being reported from 2015 to 2018 as part of the Maternal and Infant Health initiative. The Perinatal and Reproductive Health Committee recommended this measure because of its importance to women’s health.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The level of analysis is at the facility, regional and state level. The data source is administrative claims data. The care setting indicated is: Other. There is only one format of this measure.This measure was discussed by the 2015 and 2016 Task Force. The 2015 Task Force recommended this measure for inclusion, but the 2016 Task Force did not recommend this measure for inclusion into the Adult and Child Core Sets. This measure was not NQF endorsed last year. However, the 2016 Child Task Force recommended a similar measure (#2902: Contraceptive Care - Postpartum) for inclusion into the Child Core Set but the Adult Task Force did not recommend #2902 for inclusion into the Adult Core Set. #2902: Contraceptive Care – Postpartum describes the percentage of women 15-44 who had a live birth and were provided with a long-acting reversible method of contraception (LARC) or most effective or moderately effective method of contraception within 3 and 60 days of delivery.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Duals sensitive?: No; This measure is not focused on capturing individuals in both Medicare and Medicaid
  
  
• Both Medicaid Adult and Child sensitive?: Yes; This measure population encompasses women aged 15-44 years.
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a gap area identified by TF members.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure provides enhanced prevalence data on women of reproductive age at risk of unintended pregnancy who are provided with highly or moderately effective methods of contraception.
  
  
• Lead Discussant: Carol Sakala
  
  

Measure Specifications

• NQF Number (if applicable): 3166
  
  
• Description: Percentage of patients, 3 months to 5 years, prescribed antibiotic prophylaxis for at least 300 days.
  
  
• Numerator: Number of children, 3 months to 5 years, with sickle cell disease who were dispensed appropriate duration antibiotic.
  
  
• Denominator: Number of children, 3 months to 5 years, with sickle cell disease during measurement period.
  
  
• Exclusions: None
  
  
• Endorsement Status: New Measure
  
  
• Endorsement Status Notes: Public and Member Comment (Pediatric Performance Measures Phase 2)
  
  
• Measure Type: Process
  
  
• Data Source: Administrative claims
  
  
• Level of analysis: Health Plan
  
  
• Care Setting: Other
  
  
• Use in Federal Programs: n/a
  
  
• Steward: Q MetricUniversity of Michigan
  
  
• NQF Staff Notes: Measure Recommended by: Terry Adirim and Richard Antonelli; Gap Areas Addressed: Sickle cell disease; New measure included under Pediatric Performance Measures Phase 2 project. During the March 2 in-person meeting, this measure was recommended for endorsement.
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure addresses Medicaid Child gap areas: Sickle Cell Disease and Care Coordination
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a process measure. The data source is administrative claims. This is a new measure submitted for NQF endorsement. The measure is not currently used in any federal reporting programs.
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; This measure addresses Medicaid Child gap areas: Sickle Cell Disease and Care Coordination. Approximately 100,000 Americans have sickle cell disease (SCD) and it disproportionately affects African-American and Hispanic-American children with SCD diagnoses occurring for one out of every 365 Black or African-American births and 1 out of every 16,300 Hispanic-American births. Without intervention, 11 percent of children with sickle cell anemia will have a stroke by the age of 20 and the risk of stroke is most significant between ages 2 and 5. A child with SCD has a stroke risk that is 333 times greater than that of a healthy child without SCD or heart disease.The Committee noted that several of the studies were relatively old and might not include the impact of pneumococcal vaccination, which has become more prevalent. However, there is still infection risk for this population despite the vaccines developed since the studies.There is broad variation in performance among state Medicaid plans (the developer reports a range of 5.7-36%), as well as low levels of performance overall. However, significant racial or ethnic disparities in performance do not exist.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: No; This is a new measure, so it is not currently in use. However, the developer states it is working with the New York Medicaid program to implement the measure, and Committee members agreed it would be a good health plan- or state-level measure.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The Committee agreed that this measure was highly feasible, since the data elements required for the measure are routinely generated and used during care delivery, and all data elements used in the measure are defined fields in electronic claims. The level of analysis for this measure is at the health plan level and the data source is administrative claims. The developer indicated the care setting as other. There is only one version of this measure. The 2016 Child Task Force discussed this measure. The Task Force did not recommend the measure for addition to the 2017 Child Core Set. At the time of discussion, the measure had not been evaluated against the NQF criteria.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes; The measure has been submitted for NQF endorsement. This measure is included under the Pediatric Performance Measures Phase 2 project. During the in-person meeting, this measure was recommended for endorsement. The measure will be finalized in June.
  
  
• Duals sensitive?: No; Pediatric measure covering children ages 3 months to 5 years old.
  
  
• Both Medicaid Adult and Child sensitive?: No; The population only covers children ages 3 months to 5 years old.
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2016 annual meeting.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure provides enhanced prevalence data on the number of children with sickle cell anemia who are appropriately prescribed antibiotic prophylaxis.
  
  
• Lead Discussant: Terry Adirim and Richard Antonelli
  
  

Gap Area Index

• Care coordination 
  
  
• Screening for abuse and neglect* 
  
  
• Injuries and Trauma* 
  
  
• Mental health  
  
  
• Exposure to Adverse Childhood Experiences (ACEs)* 
  
  
• Overuse/medically unnecessary care* 
  
  
• Durable medical equipment (DME)* 
  
  
• Cost measures 
  
  
• Sickle cell disease 
  
  
• Substance abuse* 
  
  
• Patient-reported outcome measures* 
  
  
• Dental care access for children with disabilities* 
  
  
• Duration of children's health insurance coverage over a 12-month period* 
  
  
• Asthma 
  
  
• Maternal and Reproductive Health 
  
  

Web Meeting Comments

• Hi, this is (Sean Currigan) from ACOG. I would invite the MAP to discuss removing also postpartum care rates from adult. We agree with slide 573 on frequency of ongoing prenatal care from child, and also removing behavioral health with assessment from child. Some things that we would like you to consider adding are the use of opioid measures, 2940, 2951, 2950, the contraceptive care measures that were discussed last year, 2903, 2904, 0716, unexpected complications in term new born to the child set. And then, we wanted to make note of the screening for clinical depression and follow-up plans. CMS' specification for 2018 for MIPS includes postpartum or perinatal depression screening, the measure that went to the behavioral health panel a month ago or couple of weeks ago, did not include the expanded denominator to include pregnant women. So, we'd like you to kind of figure out how to consider the 2018 stratification of the eMeasure and the regular measure for screening for clinical depression and follow-up plan for the adult sets. Thanks. (Submitted by: Sean Currigan)
  
  

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