“You can’t improve what you can’t measure.”
As a quality improvement organization, we incorporate measurement in all our work. We have led dozens of learning collaboratives focused on various aspects of children’s health, and this has offered us many opportunities to work with frontline improvement teams to test and refine measurement strategies. We use existing measures where we can, but more often than not, we have developed new measurement sets as we seek to push the boundaries on performance and not settle for minimum standards.
As a result, NICHQ has helped raise the bar on national measurement in many areas related to children’s health and many of the measures we have developed have contributed to or become national standards. Here are some examples of areas where we have played a central role in helping set national standards for measuring progress in children’s health:
ADHD: In 2009, we developed an extensive menu of measures for a collaborative to improve care for children with ADHD. As a result of this early measurement development work, NICHQ CEO Charlie Homer was one of two physicians appointed to the expert panel that created ADHD measures for the National Committee for Quality Assurance (NCQA). Through its work with the ADHD Collaborative, we also refined a widely used Vanderbilt Assessment Scale and its scoring rubric to assist families, caregivers, and educators in the evaluation and management of children and adolescents with ADHD. The Vanderbilt Assessment Scale has been adopted by the American Academy of Pediatrics and is widely utilized in the diagnosis of children with ADHD.
Asthma: Through a variety of asthma quality improvement collaboratives in NICHQ’s early years, we developed and tested early measures for rates of anti-inflammatory use across pediatric patient populations. We also developed measures related to patient and family self-management of asthma symptoms, including overall patient satisfaction with care, the percentage of patients with planned care visits, the percentage of patients with self-management goals set during a visit, and the percentage of patients who received an asthma management plan. These measures have been integrated into various national asthma measurement sets and included in the AHRQ’s Asthma Care Quality Improvement Resource Guide.
Body Mass Index (BMI): NICHQ developed a childhood obesity performance measure for pediatric practices, which is the proportion of children ages 2-18 whose weight is classified as obese based on their body mass index (BMI) percentile and gender. This measure has been endorsed by the National Quality Forum.
Title V Index: As part of the Spread of Quality Improvement for Children and Youth with Special Healthcare Needs, we developed the Title V Index to provide a framework for Title V programs to reflect on their own capacity to make and sustain system change. The index is modeled after the Medical Home Index and consists of six care domains: overall leadership, partnerships across public and private sectors (including families), quality improvement, use of available resources, coordination of service delivery, and data infrastructure.
Autism: We worked with the Autism Speaks Autism Treatment Network to develop two decision support algorithms for constipation and insomnia, two of the most common comorbid conditions experienced by children with autism. We then developed measures to track the implementation of the algorithms and also worked with collaborative faculty to develop and track the use of a protocol for monitoring side effects of atypical antipsychotic medications in patients with autism.