QMETRIC Implementation & Quality Improvement
Project start and end dates:
QMETRIC is a multi-phase project designed to close quality gaps in the delivery of health care to children through careful assessment of provided services. Established in 2011, this federally funded initiative has led to the development of 43 tested pediatric quality measures. Several of these measures are currently the focus of further study and implementation in the project’s second phase, and two have been endorsed by the National Quality Forum (NQF).
Measurement of care is an essential step in making sure all children — infants through adolescents — receive appropriate and timely services. QMETRIC quality measures assess the provision of care across multiple clinical topic areas using administrative claims and/or medical record data. Each measure consists of a specific calculation, carefully devised to provide an accurate snapshot of actual use. Results allow for an unbiased assessment of levels of care and reveal gaps in the provision of essential services such as prescribing medications, appropriate use of neuroimaging, and timely treatment in the emergency room.
Phase 2: QMETRIC Implementation & Quality Improvement (2016-2020)
Background:
The quality of care provided to children is a topic of importance at the federal, state, health plan, and practice levels. However, there are very few validated mechanisms to assess the quality of care nor to address any deficiencies identified. To redress this issue, the QMETRIC Implementation and Quality Improvement project seeks to place children at the center of the health care quality movement. By assessing care for all children within a state, health plan, or health system, QMETRIC will implement its already-developed and validated pediatric quality measures to identify specific ways to improve pediatric population health, including more effective resource utilization and practices promoting better quality of life.
To support this goal, the QMETRIC center of excellence will field test six of the pediatric quality measures it developed during the initial phase of the federally funded Pediatric Quality Measures Improvement Project (2011-2016). Quality gaps identified through the use of those measures will form the focus of rigorous quality improvement (QI) efforts to improve care. The six measures cover antibiotic prophylaxis and transcranial Doppler screening for children with sickle cell anemia; overuse of computed tomography imaging in children with headaches or seizures; and the provision of controller and rescue medications to children with persistent asthma. All measures are claims-based and do not require costly and time-intensive chart review.
Specific Aims for this Project:
- Field testing, refinement, data collection, and reporting on the selected measures at the state, health plan, and health system levels
- Use of measure performance data to define QI goals, develop QI interventions, and test multilevel improvement strategies at the state, health plan, and health system levels
The Team:
The QMETRIC team includes five University of Michigan investigators under the leadership of principal investigator Gary L. Freed, MD, MPH: Kevin J. Dombkowski, DrPH, MS; Sarah Reeves, PhD, MPH; Katherine Bates, MD, MS; Michelle Macy, MD, MS; and Thomas Braun, PhD. Two state Medicaid programs are also participating: Michigan and New York, as are three health plans: Blue Cross Blue Shield, United Healthcare Community Plan, and Meridian Health Plan. Three health systems are committed to the project: Mott Children’s Hospital of the University of Michigan Health System, Children’s Hospital of Michigan of the Detroit Medical Center, and Hurley Children’s Hospital of the Hurley Medical Center, along with the Michigan Emergency Department Improvement Collaborative (MEDIC), a clinical collaborative.
Implications for Health Policy:
This project has a high likelihood of significant impact on the quality of care provided to children.
Measure Sets
Sickle Cell Anemia
Transcranial Doppler Ultrasonography Screening
Antibiotic Prophylaxis
Overuse of Imaging
Measure specifications coming soon
Outpatient Management of Asthma
Measure specifications coming soon
Previous Work:
To learn more about the six published sets of pediatric quality measures, please see information about the project's first phase: QMETRIC: Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium, (2011-2015)
Funding:
This work is supported by the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality.
For more information, please contact:
Julie McCormick, QMETRIC Project Manager
300 North Ingalls, Rm 6D22
Ann Arbor, MI 48109-5456
Phone: 734-615-9755
Fax: 734-232-1400
Email: mccormj@med.umich.edu
Phase 1: QMETRIC: Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium (2011-2015)
The quality of health care for children in the United States is far from optimal; assessing levels of care is an essential first step to identify areas for change. The Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium (QMETRIC) at the University of Michigan is devoted to developing quality measures designed to gauge how consistently everyday care for children measures up to established best practices. The QMETRIC team, led by principal investigator Gary Freed, MD, MPH, has conceptualized and tested more than 50 quality measures, working with expert panels, research clinicians, and data specialists. The resulting measures assess levels of essential care needed by children and their families today in six areas:
- Asthma
- Availability of Specialty Services
- High BMI Follow-Up
- Overuse of Imaging
- Sepsis Syndrome
- Sickle Cell Disease
These QMETRIC measures are among the very few pediatric quality measures in the United States that have been tested for reliability and validity and have adequate measure specifications for implementation. QMETRIC is a center of excellence (CoE) for the federal Pediatric Quality Measures Program (PQMP), which was established under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) and is funded by the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS).
To learn more about ongoing measure development work, please see information about the project’s second phase:
QMETRIC Implementation and Quality Improvement (2016-2020)
Asthma
1. Education in proper use of new asthma medication delivery device for children with asthma
2. Inhaled Corticosteroid for Children with Prescribed at Time of Discharge from the Emergency Department
Availability of Specialty Services
1. Reporting of CAHPS data regarding availability of specialist care for children on Medicaid
2. Reporting of supplemental CAHPS data regarding availability of treatment or counseling services for children on Medicaid
3. Access to Outpatient Child and Adolescent Psychiatrists, Neurodevelopmental Pediatricians, and Developmental-Behavioral Pediatricians
4. Access to Outpatient Specialty Care for Children
5. Access to Dental Care for Children
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High BMI Follow-Up
1. Documentation of BMI percentile and weight classification for children
2. Communication of weight classification for children who are overweight or obese
3. Hypertension screening for children who are overweight or obese
4. Follow-up visits for children who are overweight with a weight-related comorbidity or obese
5. Parent report of discussion of weight concerns for child
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Overuse of Imaging
To learn more about current measure development work regarding the overuse of CT scans, please visit: Phase 2 QMETRIC Implementation & Quality Improvement
1. Overuse of imaging for the evaluation of children with simple febrile seizure
2. Overuse of imaging for the evaluation of children with primary headache
3. Overuse of imaging for the evaluation of children with post-traumatic headache
4. Overuse of imaging: Policy for ALARA specific to imaging children
5. Ratio of magnetic resonance imaging scans to computed tomography scans for the evaluation of children with atraumatic headache
6. Ratio of magnetic resonance imaging scans to computed tomography scans for the evaluation of children with atraumatic seizure
7. Overuse of Computer Tomography Scans for the Evaluation of Children with Atraumatic Headache
8. Overuse of computed tomography scans for the evaluation of children with a first generalized afebrile, atraumatic seizure
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Sepsis Syndrome
1. Protocol for identifying and treating children with sepsis syndrome in the emergency department
2. (Measure discontinued)
3. Timely blood culture for children with sepsis syndrome
4. Timely antibiotics for children with severe spesis or septic shock
5. Timely fluid bolus for children with severe sepsis or septic shock
6. Documentation of heart rate during fluid resuscitation for children with severe sepsis or septic shock
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Sickle Cell Disease
To learn more about current measure development work for sickle cell anemia, please visit: Phase 2 QMETRIC Implementation & Quality Improvement
1. Timeliness of comfirmatory testing for sickle cell disease
2. Timeliness of antibiotic prophylaxis for children with sickle cell disease
3. Appropriate antibiotic prophylaxis for children with sickle cell disease
4. Appropriate outpatient blood testing for children with sickle cell disease
5. Anticipatory guidance for pain management for children with sickle cell disease
6. Anticipatory guidance for prevention and/or management of fever and severe infection in children with sickle cell disease
7. Anticipatory guidance for prevention of stroke in children with sickle cell disease
8. Anticipatory guidance regarding school attendance/performance for children with sickle cell disease
9. Anticipatory guidance for prevention and management of splenic complications in children with sickle cell disease
10. Anticipatory guidance regarding hydroxyurea treatment for children with sickle cell disease
11. (Measure discontinued)
12. Hemoglobin S monitoring prior to chronic transfusion among children with sickle cell disease
13. Transcranial Doppler ultrasonography screening for children with sickle cell disease
14. Appropriate emergency department blood testing for children with sickle cell disease
15. Appropriate emergency department fever management for children with sickle cell disease
16. Appropriate emergency department pain assessment for children with sickle cell disease
17. Appropriate emergency department pain management for children with sickle cell disease
18. Satisfaction with care from the hematologist for children with sickle cell disease
19. Satisfaction with care in the emergency department for children with sickle cell disease
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For more information, please contact:
Julie McCormick, QMETRIC Project Manager
300 North Ingalls, Rm 6D22
Ann Arbor, MI 48109-5456
Phone: 734-615-9755
Fax: 734-232-1400
Email: mccormj@med.umich.edu