national evaluation of the chipra quality demonstration grant program: early observations ahrq 2012...
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National Evaluation of the CHIPRA Quality Demonstration Grant Program:
Early Observations
AHRQ 2012 Annual ConferenceMoving Ahead: Leveraging Knowledge and Action
to Improve Health Care Quality
Tuesday, September 11, 2012
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
The National Evaluation Team
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Overview of the CHIPRA Quality Demonstration Grant Program
Goals and methods of the national evaluation
Early observations about practice-level reporting of quality measures
Today’s Presentation
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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
The CHIPRA Quality Demonstration Program
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CHIPRA Quality Demonstration Program (cont’d)
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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)
States A B C D E
Oregon*
Alaska
West Virginia
Maryland*
Georgia
Wyoming
Utah*
Idaho
Florida*
Illinois
Maine* ,
Vermont
Colorado*
New Mexico
Massachusetts*
South Carolina*
Pennsylvania*
North Carolina*
Demonstration Grantees* and States, by Grant Category
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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
Example of Within Category Variation: States’ Activities Related to Quality Measures
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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: Goals
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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
National Evaluation: Methods
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Used information from 4 states: Maine, Massachusetts, North Carolina, Pennsylvania
Site visits conducted: March – August 2012
Results to be published in October issue brief
Early Observations About Practice-Level Reporting
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Practice-level reporting: Very different 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?
What are States Learning AboutPractice-Level Reporting?
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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
Practice-level Reporting: Take Away Messages
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National Evaluation 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
Web Page
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For more information or to share your good ideas, contact:
Henry T. Ireys, PhD
Senior Fellow, Mathematica Policy Research
202-554-7536
Contact Information
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