4 New Views on Quality 4 Kids

May 3, 2022 · Andy Reynolds

NCQA staff were co-authors on four peer-reviewed publications in a recent edition of the journal Academic Pediatrics. All four publications deal with issues crucial to quality care for children.

1. Integrating Youth Voice in Health Plan Quality Improvement

summarizes health plans’ experience using patient feedback to improve care for adolescents with depression.

Efforts to improve the quality of care for kids usually consider what parents or guardians want and rarely ask kids for input. Even health plans that want to include their feedback often don’t know how.

Involving kids in improving their care is possible—but hard. This study helps show how sustained commitment and working through local youth groups can result in success.

NCQA’s Serene Olin, Sarah Scholle and Cindy Van worked with Youth Move’s Kirsten Thorp on this report.

2. Aligning to Improve Pediatric Health Care Quality

included Serene and Sarah as co-authors. This publication focused on:

• Use of antipsychotic medications among children enrolled in Medicaid—a topic the Wall Street Journal brought wide exposure to in 2013.
• Care for sickle cell anemia—a disease most prevalent in African Americans, highlighting health equity issues.

Valid, reliable quality measures are necessary, but alone are not sufficient to improve care. Incentives, aligning priorities across the delivery system and a willingness to adopt a population health strategy are key.     

3. Health Plans Struggle to Report on Depression Quality Measures That Require Clinical Data

focuses on five HEDIS measures that use electronic clinical data to assess the quality of care for adolescent and perinatal depression.

The authors (including NCQA’s Sepheen Byron, Emily Morden, Lindsey Roth, Serene Olin and Sarah Scholle) found that reporting and improving performance for these measures isn’t always easy for health plans. Why? Two big reasons are that plans may not have access to clinical data—and providers don’t always perform recommended depression screenings.

(To learn which measures work best with electronic reporting, see Reporting Results for Measures Leveraging Electronic Clinical Data for HEDIS.)

4. Enhancing Quality Measurement With Clinical Information: A Use Case of Body Mass Index Change Among Children Taking Second Generation Antipsychotics was co-authored by Sarah Scholle.

This study considered:

• Whether Florida Medicaid EHRs contained BMI of children who take second-generation antipsychotics (SGAP).
• How clinical data can identify children most at risk for SGAP-induced weight gain.

Because SGAP can disrupt metabolism, using them to treat mental illness may increase kids’ risk for obesity.

The study found that although BMI information is useful, its presence in EHRs is inconsistent, leaving kids for whom BMI is not reported at risk of worse care.

The study noted more weight gain among kids taking SGAP—particularly kids whose BMI was already higher.

(Longtime HEDIS users might wonder, “Didn’t NCQA retire the HEDIS BMI measure?” We retired Adult BMI Assessment in 2020 because changes in ICD10 coding made BMI data appropriate only for adults at unhealthy weight. But BMI remains useful for the HEDIS measure used in the study, Metabolic Monitoring for Children and Adolescents on Antipsychotics).  

Zooming Out

Taken as a group, these studies stand out for their:    

• Connection to Half the Kids in the US: All four studies are part of the Agency for Healthcare Quality and Research (AHRQ) Pediatric Quality Measures Program (PQMP). The PQMP shapes the Child Core Set of quality measures.
  
  The Core Set has astounding reach: Together, Medicaid and the Children’s Health Insurance Program Reauthorization Act (CHIPRA) cover half the children in the US.
  
  Little was known about pediatric care quality before 2009 legislation created CHIPRA and the Core Set—there just weren’t many pediatric quality measures before then. We are proud to contribute to the growing understanding of the health and health care of American children.

• Contributions of Two Medicaid Directors: Doctors who run state Medicaid programs were co-authors on two of the studies.
  
  Their involvement adds relevance and credibility because they are leaders who use measures to gauge the quality of care for children in Medicaid.
  
  David Kelley, Chief Medical Officer for the Pennsylvania Department of Human Service’s Office of Medical Assistance Programs, contributed to the study about reporting depression measures that require clinical data. Mary Applegate, Medical Director for Ohio Medicaid, contributed to the alignment study involving antipsychotic medications and care for sickle cell anemia.
  
  (Dr. Applegate is synonymous with alignment, thanks to an alignment model she created for population health that underlies the Behavioral Health Quality Framework NCQA supports.)

• Real-World Proving Ground: Three studies are in the National Collaborative for Innovation in Quality Measurement (NCINQ), of which NCQA is a part.
  
  NCINQ is distinct as the only PQMP Center of Excellence (COE) that puts measures into an accountability program: HEDIS. Other COE are academic centers that aren’t part of a real-world testing ground.
  
  Just as the contribution of two Medicaid directors enhances the credibility of these studies, so too does the use of NCINQ measures in HEDIS.

Look for more pediatric research from NCQA and NCINQ in the future.