Child and Adolescent Health Measurement Initiative CAHMI An Overview

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Child and Adolescent Health Measurement
Initiative (CAHMI) An Overview
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Child Adolescent Health Measurement Initiative
(CAHMI)

• Established in 1998 by FACCTThe Foundation for
  Accountability and NCQAThe National Committee on
  Quality Assurance
• Provides leadership resources for measuring and
  communicating information about the quality of
  health care for children and adolescents.
• Over 70 consumer organizations, policymakers,
  researchers, health care practitioners, health
  plans and health care purchasers have
  participated in the CAHMI since May, 1998.

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Mission

• The CAHMI is committed to ensuring that
  families, purchasers, policymakers and providers
  have relevant and actionable information about
  health care quality that can be used to help
  families make better health care decisions and
  that can improve health care quality and the
  health of children, adolescents and families.

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1998-2000 Structure

• National advisory committee
• shapes priorities products
• recommends measures and strategies to staff
  external groups
• creates a forum for collaboration, learning
  idea generation
• Three topic specific task forces
• specify measurement topics characteristics
• advise on testing and validation process
  findings
• recommend methodology for measurement
  collaborate on publications
• Staffed by FACCT
• coordinate work and involvement of committees
  task forces
• develop and execute measures development
  testing protocols
• provide technical and strategic support to states
  other users
• Extensive in-kind hired support from
  collaborators

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1998-2000 Goals

• Frame and Organize Articulate a framework for
  measuring and reporting on health care quality
  for children and adolescents and establish a
  supporting national collaborative on this issue
• Create and Validate Develop and test a core set
  of measures on priority topics, populations and
  units of analysis (e.g. MCOs, MD groups)
• Document and Disseminate Develop standardized
  specifications, publish testing results and
  disseminate tools
• Deploy and Demonstrate Support application of
  measures and demonstrate use by priority users --
  priority on state, MCO and national use of
  measures
• Educate and Motivate Be a voice for the
  measurement of child and adolescent quality
  measurement and reporting in national and state
  forum and encourage efforts to use quality
  information to educate and empower
  consumers/families

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1998-2000 Funding

• David and Lucille Packard Foundation
• Core funding 1998-2001 through grants to FACCT
• Supports CAHMAC and task forces, CSHCN and YAHCS
  measures development, testing and application,
  HEDIS process, state pilot of all new CAHMI
  tools, consumer input, management,
  communications, publications, website and
  strategic planning
• The Commonwealth Fund
• Funded bulk of PHDS/early childhood measures
  development and testing
• The Robert Wood Johnson Foundation
• Early funding for CSHCN measures development

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1998-2000 Funding

• Agency for Healthcare Research and Quality
• Funding for NCQA involvement in 1998-1999
• Support CAHPS team involvement in CSHCN measures
  development
• Other Federal Agencies
• CDC contracts with FACCT to support NCHS/SLAITS
  use of CSHCN tools
• MCHB support to external collaborators to support
  CSHCN trials
• HCFA contract to support development of toolkit
  for states to identify CSHCN

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Quality Tools Developed

• Early childhood health promotion, prevention
  development (PHDS)
• Survey-based measures for use in quality
  reporting EPSDT evaluations, quality improvement
  national assessment of Bright Futures
  guidelines --
• 8 quality measures
• Young adult/adolescent health promotion and
  prevention (YAHCS)
• Survey- based measures for use in quality
  reporting EPSDT evaluations, quality improvement
  and national assessment of Bright Futures
  guidelines
• 7 quality measures

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Quality Tools Developed (cont.)

• Children with special health care needs (CSHCN
  module)
• screener, sampling strategy and question
  supplement -- for use with CAHPS and other
  surveys (e.g. BRFS, MEPS, SLAITS)
• 10-15 quality measures with CAHPS
• Avoidable hospitalization for young children with
  acute conditions (drafted)
• 1 quality measures

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CAHMI Measures

• Yield 26 quality measures and tools with
  multiple applications
• Reflect national guidelines and health goals
• Responsive to state and MCO needs
• Relevant to families and consumers
• Tested with over 56,000 families in seven states
  and over 21 MCOs as of December 2000
• Many adaptation opportunities for use with
  medical groups and alternative applications (e.g.
  QI, program evaluation, etc.)
• Ongoing refinements as measures are used are
  expected
• -- need to keep the measures

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National and State Applications

• CSHCN measures accepted for HEDIS 2001 (pending
  public review)
• HEDIS process initiated for adolescent preventive
  care measures
• Unsolicited consultations provided to over 26
  states using or planning to use one or more CAHMI
  tools
• Statewide pilot project in Washington State
  demonstrates use of all new CAHMI measures in one
  state
• Advise on and support four national applications
  of CAHMI tools -- MEPS, SLAITS/CSHCN, SLAITS/
  NSECH, RWJF national indicators pjt.

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Measure Development

• All development work guided by CAHMIs Six-Stage
  Measurement Development Process
• Conceptual framework and relevance
• Starting point proposal review
• Methods specification and study design
• Field testing
• Revision and refinement
• Document and disseminate

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Measure Development

• CAHMI Measure Selection Development Criteria
• Meaningful
• Consumer relevance
• Discriminating and actionable
• Non-redundant w/ current measurement
• Feasible
• Short, survey-based, dual mode(mail telephone)
• Compatible with existing tools where possible
• Minimize burden
• Sound
• Reliable - psychometric reliability, cognitive
  ease
• Valid - face, content, concurrent, criterion

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CAHMI State Pilot Project

• Demonstrate relevance feasibility of CAHMI
  quality measures through a statewide Medicaid
  application
• Develop results feedback materials strategies
  to communicate information about quality to
  Medicaid clients, health plans other
  constituencies (e.g. county public health
  agencies)
• Support state efforts to develop a sustainable
  integrated, family-centered quality measurement
  communications strategy

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CAHMI / WA State Medicaid Pilot Study

• FACCT/CAHMI collaborated on
• Planning coordination of key players
• Sampling data collection
• Technical support to contractors
• Analysis creation of quality measures
• Production of quality reports (e.g. health plan,
  county, state-level)
• Evaluation strategic dialogue

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CAHMI / WA State Medicaid Pilot Study

• WA States activities
• Involve stakeholders (especially American Indian
  clinics and Snohomish County groups)
• Communication bridge between FACCT contractors
• Answer client questions via subcontractor, phone
  lines
• Plan for the end game (reports distribution)
• Contract management

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CAHMI / WA State Medicaid Pilot Study

• Over 16,000 Washington State Medicaid clients
  responded to the surveys
• 15,685 families of children 737 adolescents.
• FACCT/CAHMI produced extensive results reports
  for use by state and county health agencies and
  health plans (40 reports)
• The WA State Dept of Health the Medical
  Assistance Administration using CAHMI measure
  results generated from these consumer-responses
  in number of ways

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CAHMI / WA State Medicaid Pilot Study

• Products
• Client brochure w/ CSHCN results distributed
  during Fall 2000 enrollment period
• 300 copies of CAHPS/CSHCN stakeholder report
  distributed
• Promoting Healthy Development (PHD)
• results included in EPSDT
• County level PHD, YACHS sent to
• committee chairs
• Plan-level reports and data sent to plans
• Data shared with Department of Health

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Washington State MAA

• Motivation for participation in CAHMI pilot
• Commitment to preventive health
• Commitment to improved care and services for
  children and adolescents
• Need to develop measures for previously
  overlooked populations
• Close tie to Department of Health maternal child
  health programs

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CAHMI Fit with MAA Quality Vision

• Vision Statement
• The Quality Management Section staff will use
  state-of-the-art quality improvement principles,
  tools, and methods to promote improved quality
  and access to health care services for MAA
  clients.

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Quality Improvement Mission

• The Quality Improvement Unit (QI) provides
  guidance, oversight, evaluation, analysis, and
  reports to the Medical Assistance Administration
  to improve the quality of care and services for
  Healthy Options, Fee-for-Service, and CHIP
  clients.
• Framework for quality assessment provides for
  structure, process, and outcome measurement

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Game Plan for the Presentation
Break
Hour 1
Hour 2
Hour 3
YAHCS Assessing preventive care for adolescents
(14-18 yrs. old) 40 minutes of presentation 20
minutes of Q A
CSHCN Identifying children with special health
care needs and assessing their care 40 minutes
of presentation 20 minutes of Q A
PHDS Assessing preventive care for young
children (3-48 mos. old) 40 minutes of
presentation 20 minutes of Q A
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Outline for Measure-Specific Presentations

• 1) Background Information about the CAHMI measure
• Development
• Testing
• 2) Technical Description of the CAHMI measure
• Information that is gathered disseminated
• 3) WA State Pilot Experience
• 4) Group questions / discussion