You can’t improve what you can’t measure: This is the core principle of national, state and local efforts to increase health care quality and safety. While adult health care has benefitted for many years from a variety of measures of quality and safety, though, pediatrics has generally lagged behind.
In 2011, the Agency for Health Care Research and Quality and the Centers for Medicare & Medicaid Services (CMS) launched the Pediatric Quality Measures Program (PQMP), a group of seven centers of excellence tasked with developing measures and measurement tools for different aspects of pediatric care. Those measures are starting to come online, with a survey developed by the Center of Excellence for Pediatric Quality Measurement (CEPQM) at Boston Children’s Hospital being one of the first out of the gate.
Called the Consumer Assessment of Healthcare Providers and Systems Hospital Survey – Child Version (Child HCAHPS), the survey asks a child’s parents or caregivers to rate their family’s hospital experience based on 18 composite and single-item measures. The survey was recently endorsed by the National Quality Forum (NQF), and CMS is gearing up to test of a process for reporting Child HCAHPS results nationwide. It has also been adopted by many pediatric hospitals across the country, including Boston Children’s.
Notes asked CEPQM director Mark Schuster, MD, PhD, and managing director Sara Toomey, MD, MPH, a few questions about Child HCAHPS and how it fits into the overall scheme of pediatric care quality improvement.
Q: Why this emphasis in measuring the quality of care in pediatrics?
Schuster: If we don’t know how we’re doing, we don’t know where we need to focus in order to do better. Quality measurement tells us how we’re doing, makes us accountable, informs accreditation processes and can answer critical research questions about care disparities, policy changes and innovations. Adult health care providers have been relying on the adult version of the HCAHPS survey for the last decade; it’s time to bring the same rigor and family input to pediatrics.
Q: How does Child HCAHPS support quality measurement?
Toomey: It captures the family perspective and voice. This is a lesson we’ve learned from the adult world. Patients who have a positive experience with their care are more likely to take the medication and to come in for follow-up when necessary. It’s the same in pediatrics. If a family is unhappy with their care, they’re less likely to seek care when they need it or to follow through on the plans we recommend. If we’re not delivering care in a way that addresses what a family wants or needs, we want to hear about it.
Q: Are there other surveys that address similar questions?
Schuster: Several survey vendors offer surveys that measure patient and family experience for adult and pediatric care, but we’ve lacked a single survey tailored to inpatient pediatrics that is available for anyone to use and allows for ready comparison across hospitals.
Q. Will Child HCAHPS data factor into payors’ hospital reimbursement decisions going forward?
Toomey: At a national level, no. Publicly insured pediatric care is run through state Medicaid offices rather than a federal agency, and as such, CMS has not been penalizing pediatric hospitals for not meeting care quality measures. As for whether individual states or private payors will choose to incorporate Child HCAHPS data into their reimbursement processes, we can’t say.
Q: Is CEPQM working on other quality measures?
Schuster: We have three measures that have received NQF endorsement to date: Child HCAHPS, Pediatric All-Condition Readmission Measure and Pediatric Lower Respiratory Infection Readmission Measure. We are also working on two other assignments, for the Global Pediatric Patient Safety Trigger Tool and the Children with Disabilities Algorithm. Over time, we hope that these and other measures being developed by the other six PQMP centers of excellence will provide a major leap forward in our ability to measure and improve pediatric care quality across the country.
To learn more about Child HCAHPS, contact the CEPQM at ChildHCAHPS@childrens.harvard.edu.