TABLE 1

CHIPRA Measures Feasible in Our Outpatient EHR Data, and Suggested Adaptations Needed

Summary of Original CHIPRA MeasureSuggested Adaptations for Application in EHR DataRelevant Adaption Themesa
1Timeliness of PNCI, II
 N: Number who received PNC with appropriate timelinessN: Same
 D: Live births to continuously enrolled women in the measurement yearD: Women with both ≥1 PNC visit, and ≥1 WCV or postpartum visit, in the measurement year
2Frequency of PNC
 N: Number who received PNC with appropriate frequencyN: Same
 D: Live births to continuously enrolled women in the measurement yearD: Women with both ≥1 PNC visit, and ≥1 WCV or postpartum visit, in the measurement year
3Cesarean deliveries: data from regional vital statistics recordsI, II
 N: Number delivered by cesarean deliveryN: Same
 D: Live births in the measurement yearD: Women with both ≥1 PNC visit, and ≥1 WCV or post partum visit, in the measurement year; obtain EHR data
4Low birth weight births: data from regional vital statistics records
 N: Number with birth weight <2500 g, and a Medicaid/Children’s Health Insurance Programs payerN: Number with birth weight <2500 g
 D: Live births in the measurement yearD: Women with both ≥1 PNC visit, and ≥1 WCV or post partum visit, in the measurement year; obtain EHR data
5Annual Chlamydia screeningI, III
 N: Number who had a Chlamydia screening in the measurement yearN: Same
 D: Women aged 16–24, with continuous enrollment in the measurement year, who are identified as sexually active using an algorithm that includes codes for pregnancy testing and care, STIs, and dispensed prescription contraceptive medications. (In the original measure, a person is considered sexually active if these codes are seen at any point during the measurement year. In the example presented in Table 3, a person is considered sexually active if identified as such in the medical record at any point prior to or including the first visit in the measurement year).D: Women aged 16-24, with ≥1 visit in the measurement year, who are identified as sexually active using an algorithm which includes codes for pregnancy testing and care, STIs, and prescribed contraceptive medications, augmented by data from the EHR social history section
6Immunization status: 0–2 yI
 N: Number who received recommended immunizations by age 2 yN: Same
 D: Children with continuous enrollment in the measurement yearD: Children / adolescents with ≥1 visit in the measurement year (We do not suggest requiring a visit in the year prior, as rates of vaccination among persons who had any visit identifies “missed opportunities” for vaccination.)
7Immunization status: 11–13 yI
 N: Number who received recommended immunizations by age 13 yN: Same
 D: Adolescents with continuous enrollment in the measurement yearD: Children / adolescents with ≥1 visit in the measurement year (We do not suggest requiring a visit in the year prior, as rates of vaccination among persons who had any visit identifies “missed opportunities” for vaccination.)
8BMI percentile documentationI
 N: Number who had BMI percentile documented (using ICD9 codes) in the measurement yearN: Same, augmented by BMI data from the EHR
 D: Children / teens with continuous enrollment, and ≥1 visit, in the measurement yearD: Children / teens with ≥1 visit in the measurement year
9Well-child care: InfantsI
 N: Number who had appropriate number of well-child checks by 15 moN: Same
 D: Children with continuous enrollment in the measurement yearD: Children with ≥1 visit in the measurement year
10Well-child care: Age 3–6 yI
 N: Number who had appropriate number of well-child checks in years 3-6N: Same
 D: Children with continuous enrollment in the measurement yearD: Children with ≥1 visit in the measurement year, and ≥1 visit in the year prior
11Well-child care: Age 12–21 yI
 N: Number who had the appropriate number of well-child checks in years 12–21N: Same
 D: Children with continuous enrollment in the measurement yearD: Children with ≥1 visit in the measurement year, and ≥1 visit in the year prior
12Developmental screening: Age 12–36 moI
 N: % of children who were screened for risk of developmental, behavioral, and social delays using a standardized screening tool in the first 3 years of lifeN: Same
 D: Children with continuous enrollment in the measurement year (Although developmental screening is not reported in a standardized way in our data, this measure would be feasible with consistent reporting).29D: Children with ≥1 visit in the measurement year, and ≥1 visit in the year prior
13Follow-up on ADHD medicationIII
N: (a) Number with ≥1 in-person follow-up visit within 30 d of dispense date; (b) no. in (a) who also had ≥2 follow-up visits within 31–300 d of dispense dateN: (a) Number with ≥1 in-person follow-up visit within 30 d of prescription date; (b) no. in (a) who also had ≥2 follow-up visits within 270 d of initial prescription
D: Children age 6–12 y, continuously enrolled 120 d pre- and 30 d postambulatory dispense of an ADHD medication, who stayed on the medication ≥210 dD: Children aged 6–12 y who were prescribed an ADHD medication, and stayed on it for ≥210 d; duration of prescription may need to be estimated
14Annual HbA1c testingIII
 N: Number with documentation of date and result of most recent HbA1c test [Requires manual chart review]N: Same [Does not require manual chart review]
 D: Children age 5–17 y, ≥2 visits with diabetes diagnosis over the past 2 y, and /or notation of prescribed insulin or oral hypoglycemics / antihyperglycemics for ≥12 moD: Children age 5–17 y, ≥2 visits with a diabetes diagnosis over the past 2 y, and/or notation of same prescribed meds as in original; duration of prescription may need to be estimated
15Strep testing when dispensing antibioticsI, III; also no ED data
 N: Number with a strep test administered in the 3 d prior to 3 d after the date of the pharyngitis diagnosisN: Same
 D: Children aged 2–18 y, with continuous enrollment in the measurement year, who had an outpatient or ED visit with a diagnosis of pharyngitis, and were dispensed an antibioticD: Children aged 2–18 y who had an outpatient visit with a diagnosis of pharyngitis, and were issued an antibiotic prescription
16Antimicrobials for otitis mediaNone
 N: Number not prescribed systemic antimicrobial agentsN: Same
 D: Patients aged 2 mo to 12 y with an OME diagnosisD: Same
  • D, denominator; ED, emergency department; HbA1c, Hemoglobin A1c; ICD9, International Classification of Diseases, Ninth Revision; N, numerator; OME, otitis media with effusion.

  • a Adaptation themes include (I) Defining a population denominator; (II) Calculating data on trimester at enrollment by using available EHR data; (III) Substituting for medication dispense data.