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American Academy of Pediatrics
Special Article

Feasibility of Evaluating the CHIPRA Care Quality Measures in Electronic Health Record Data

Rachel Gold, Heather Angier, Rita Mangione-Smith, Charles Gallia, Patti J. McIntire, Stuart Cowburn, Carrie Tillotson and Jennifer E. DeVoe
Pediatrics July 2012, 130 (1) 139-149; DOI: https://doi.org/10.1542/peds.2011-3705
Rachel Gold
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Heather Angier
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Rita Mangione-Smith
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Charles Gallia
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Patti J. McIntire
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Stuart Cowburn
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Carrie Tillotson
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Jennifer E. DeVoe
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Abstract

The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) includes provisions for identifying standardized pediatric care quality measures. These 24 “CHIPRA measures” were designed to be evaluated by using claims data from health insurance plan populations. Such data have limited ability to evaluate population health, especially among uninsured people. The rapid expansion of data from electronic health records (EHRs) may help address this limitation by augmenting claims data in care quality assessments. We outline how to operationalize many of the CHIPRA measures for application in EHR data through a case study of a network of >40 outpatient community health centers in 2009–2010 with a single EHR. We assess the differences seen when applying the original claims-based versus adapted EHR-based specifications, using 2 CHIPRA measures (Chlamydia screening among sexually active female patients; BMI percentile documentation) as examples. Sixteen of the original CHIPRA measures could feasibly be evaluated in this dataset. Three main adaptations were necessary (specifying a visit-based population denominator, calculating some pregnancy-related factors by using EHR data, substituting for medication dispense data). Although it is feasible to adapt many of the CHIPRA measures for use in outpatient EHR data, information is gained and lost depending on how numerators and denominators are specified. We suggest first steps toward application of the CHIPRA measures in uninsured populations, and in EHR data. The results highlight the importance of considering the limitations of the original CHIPRA measures in care quality evaluations.

KEY WORDS
  • health care quality assessment
  • health care quality indicators
  • pediatric care quality assessment
  • CHIPRA measures
  • electronic health record data collection
  • Abbreviations:
    ADHD —
    attention-deficit/hyperactivity disorder
    CHC —
    community health center
    CHIPRA —
    Children’s Health Insurance Program Reauthorization Act
    CPT —
    Current Procedural Terminology
    OCHIN —
    Oregon Community Health Information Network
    PNC —
    prenatal care
    WCV —
    well-child visit
    • Accepted March 8, 2012.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 130, Issue 1
    1 Jul 2012
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    Feasibility of Evaluating the CHIPRA Care Quality Measures in Electronic Health Record Data
    Rachel Gold, Heather Angier, Rita Mangione-Smith, Charles Gallia, Patti J. McIntire, Stuart Cowburn, Carrie Tillotson, Jennifer E. DeVoe
    Pediatrics Jul 2012, 130 (1) 139-149; DOI: 10.1542/peds.2011-3705

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    Feasibility of Evaluating the CHIPRA Care Quality Measures in Electronic Health Record Data
    Rachel Gold, Heather Angier, Rita Mangione-Smith, Charles Gallia, Patti J. McIntire, Stuart Cowburn, Carrie Tillotson, Jennifer E. DeVoe
    Pediatrics Jul 2012, 130 (1) 139-149; DOI: 10.1542/peds.2011-3705
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