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National Evaluation of the CHIPRA Quality Demonstration Grant Program: Early Observations. AHRQ 2012 Annual Conference Moving Ahead: Leveraging Knowledge and Action to Improve Health Care Quality Tuesday, September 11, 2012. The National Evaluation Team.
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National Evaluation of the CHIPRA Quality Demonstration Grant Program: Early Observations AHRQ 2012 Annual Conference Moving Ahead: Leveraging Knowledge and Action to Improve Health Care Quality Tuesday, September 11, 2012
The National Evaluation Team • Mathematica: H. Ireys, L. Foster, C. McLaughlin, A. Christensen, G. Ferry, B. Natzke, others • Urban: K. Devers, J. Kenney, I. Hill, R. Burton, S. McMorrow, others • AcademyHealth: L. Simpson, V. Thomas • AHRQ: C. Brach, S. Farr • CMS: K. Llanos, E. Hill
Today’s Presentation • Overview of the CHIPRA Quality Demonstration Grant Program • Goals and methods of the national evaluation • Early observations about practice-level reporting of quality measures
The CHIPRA Quality Demonstration Program • Congressionally mandated • $100 million dollar program • Large federally-funded efforts specifically focused on improving quality of child health care • Five-year grants awarded by CMS to 10 grantees, involving 18 states, Feb. 2010 • National evaluation overseen by AHRQ, Aug. 2010 – Sept. 2015
CHIPRA Quality Demonstration Program (cont’d) • Focus on five strategies to improve quality • Show how quality measures can be used to improve quality of care for children (Category A) • Demonstrate utility of HIT/EHR applications (Category B) • Implement provider-based models (Category C) • Apply model format for EHRs for children (Category D) • Other innovative approaches to improve quality (Category E)
Example of Within Category Variation: States’ Activities Related to Quality Measures • Expand, build on existing data and reporting infrastructure, such as warehouses, linked datasets • Apply measures at practice, system, and state levels • Develop new measures, beyond core measure set • Report performance to various audiences: providers, health plans, families/public, policymakers • Link performance on measures to incentives 7
National Evaluation: Goals • Goals • Identify effective strategies to improve quality of children’s health and health care • Disseminate information about what works, why it works, and what’s worth replicating • “Tell the stories” of projects, categories, states, grantees
National Evaluation: Methods • Mixed-Methods Design • Quantitative (claims/administrative files) & qualitative (site visits, document review) • Descriptive/compare-and-contrast analysis of program implementation • Comparative analysis of trends/outcomes • Impact analyses for selected medical home projects • Multiple levels of analyses: patient, provider, practice, network, regional, state, grantee, groups of grantees
Early Observations About Practice-Level Reporting • Used information from 4 states: Maine, Massachusetts, North Carolina, Pennsylvania • Site visits conducted: March – August 2012 • Results to be published in October issue brief
What are States Learning AboutPractice-Level Reporting? • Practice-level reporting: Verydifferent from state-level reporting • Technical challenges re: accessing data sources from multiple systems, defining quality measure denominators • Data collection via providers: Managing burden, expectations • Two questions particularly important to practices • Can my practice influence these measures? • Are these measures useful for our QI efforts?
Practice-level Reporting: Take Away Messages • An essential step: Involving physician practices in selecting measures for quality-improvement projects • Adapting measures originally designed for state-level: An unexpectedly resource-intensive task • States are actively turning to EHRs and HIEs • Barriers: Outdated, undeveloped, or unsophisticated health IT, data infrastructures
Web Page • http://www.ahrq.gov/chipra/demoeval/ • Features • Clickable map of the demonstration states • State-at-a-Glance descriptions • Category descriptions • More about the national evaluation • Reports & Resources: Findings, issue briefs
Contact Information For more information or to share your good ideas, contact: Henry T. Ireys, PhD Senior Fellow, Mathematica Policy Research 202-554-7536 hireys@mathematica-mpr.com