NQF Endorses 41 Standards of Pediatric Care

NQF Endorses 41 Standards of Pediatric Care

Cheryl Clark, for HealthLeaders Media , August 22, 2011

Nearly four months after the Institute of Medicine issued its report calling for quality measures to evaluate the state of pediatric care, the National Qualify Forum has endorsed 41 such standards and expects that payers will soon put most into practice.

Eventually, many are expected to be used by health insurance plans and state Medicaid programs as markers for pay for performance. Eventually, scores would be posted on HospitalCompare or PhysicianCompare.

For the first time, these measures ask for the frequency with which pediatricians and other clinicians screen newborns for hearing loss, and screen all children with audiology testing prior to their hospital departure, and again no later than three months of age.

Four measures call for evaluating the frequency in which children receive certain types of dental care, including whether their oral care visits include the use of fluoride varnish.

"It's an exciting...opportunity to have some measures on dental care for kids, which is an important area that has not been recognized to date," Helen Burstin, MD, NQF senior vice president for performance measures, noted in an interview.

The NQF also recommended age intervals for developmental screening, blood pressure testing, vision, chlamydia screening and followup, childhood overweight or obesity, levels of physical activity, and how many children are exposed to secondary smoke inside the home.

Also new in this set of measures, the NQF addresses ways to evaluate mental health care for children. The full list of NQF endorsed measures can be found here.

Perhaps among the most debated items on the list, Burstin said, is one that calls for reporting of percentages of newborns in which birthweight is less than 2,500 grams, or 5.51 pounds. "There has been a great deal of interest in some of the measures around low birth weight, because that represents an opportunity to begin comparing at a population level," Burstin said.

The NQF reviews the accumulation of evidence that a particular practice is sound and a way to compare quality of care. When a certain measure reaches a threshold, it comes up for review by NQF panelists and others and is eventually approved or postponed for more information.

For example, the NQF wants providers to count "the percentage of children who turned 6 months old during the measurement year and who had sudden infant death," or "the percentage of children who turned 2 years old during the measurement year who had a developmental screening and proper follow-up performed between 6 months and 2 years of age."

"A real goal of quality measurement is improvement, and you can't improve what you can't measure. We have to start at the measurement phase," she said.

For some of these measures involving screening, we know that providers should be doing these things 100% of the time, Burstin explained.But for many of the newly endorsed measures, "it's more of an issue of the need to get comparative data, and you're not going to get comparative data until people begin measuring, so it's a bit circular.But by putting comparative data out there, you get a standard set of child health quality measures and more information on the current state of child health. "

Asked why so many measures exist for non-pediatric types of care, such as for patients with heart attack, pneumonia, or congestive heart failure, Burstin gave three possible reasons.

First, she said, the evolution of CHIPRA, the 2.5-year old Children's Health Insurance Program Reauthorization Act, designed to improve eligibility and coverage for children, is now using many of these and other measures.

Second, she said, there previously was a stronger emphasis on Medicare and the older adult, perhaps since more federal dollars were spent on care for people 65 and older.

But third, she said that "there's been a greater emphasis recently in thinking about wellness and what measures could be used to assess child health wellness and development."

Gaps, however, remain for measures focused on child function, health-related quality of life, patient and caregiver experience with care, pediatric inpatient care, promotion of healthful behaviors, and other areas, according to an NQF summary report on the latest endorsements.

Burstin said that some didn't make the cut because of the difficulty to reliably collect information from the medical record.

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