Data from EHRs May Provide Insights into Quality of Children’s Care

Overly strict adherence to measures that define the quality of health care that children receive under the Children’s Health Insurance Program may overlook the true quality of care provided, especially among children who use health services sporadically, a new AHRQ-funded study finds. Quality measures developed as a result of Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 calculate care quality based on health insurance claims data. However, claims data may not capture as many facets of patient care as electronic health records (EHRs), according to the study authors. While claims data capture information generated during the period a patient is insured through a health plan, EHRs can capture information about patient care regardless of health insurance status. The article, “Are Pediatric Quality Measures Too Stringent?” appeared in the October issue of the Journal of the American Board of Family Medicine. Select to access the abstract on PubMed.®

J Am Board Fam Med. 2012 Sep-Oct;25(5):686-93. doi: 10.3122/jabfm.2012.05.120041.

Are pediatric quality care measures too stringent?

Casciato A, Angier H, Milano C, Gideonse N, Gold R, DeVoe J.

Source

Department of Family Medicine, Oregon Health & Science University, Portland, OR 27239, USA. casciato@ohsu.edu

Abstract

INTRODUCTION:

We aimed to demonstrate the application of national pediatric quality measures, derived from claims-based data, for use with electronic medical record data, and determine the extent to which rates differ if specifications were modified to allow for flexibility in measuring receipt of care.

METHODS:

We reviewed electronic medical record data for all patients up to 15 years of age with ≥1 office visit to a safety net family medicine clinic in 2010 (n = 1544). We assessed rates of appropriate well-child visits, immunizations, and body mass index (BMI) documentation, defined strictly by national guidelines versus by guidelines with clinically relevant modifications.

RESULTS:

Among children aged <3 10="10" 15="15" 2="2" 36="36" 3="3" 52.4="52.4" 60.8="60.8" 63="63" 91="91" a="a" age="age" aged="aged" among="among" attended="attended" before="before" birthday="birthday" bmi="bmi" by="by" children="children" completed="completed" date.="date." had="had" less="less" measurement="measurement" modifications="modifications" months="months" of="of" p="p" percentile="percentile" recorded="recorded" second="second" series="series" than="than" the="the" their="their" to="to" up="up" vaccination="vaccination" visits="visits" well-child="well-child" were="were" with="with" within="within" year.="year." years.="years." years="years">

CONCLUSIONS:

Applying relevant modifications to national quality measure definitions captured a substantial number of additional services. Strict adherence to measure definitions might miss the true quality of care provided, especially among populations that may have sporadic patterns of care utilization.