Are pediatric quality care measures too stringent?

Abstract

Introduction: We aimed to demonstrate the application of national pediatric quality measures, derived from claims-based data, for use with electronic medical record data, and determine the extent to which rates differ if specifications were modified to allow for flexibility in measuring receipt of care.

Methods: We reviewed electronic medical record data for all patients up to 15 years of age with ≥1 office visit to a safety net family medicine clinic in 2010 (n = 1544). We assessed rates of appropriate well-child visits, immunizations, and body mass index (BMI) documentation, defined strictly by national guidelines versus by guidelines with clinically relevant modifications.

Results: Among children aged <3 years, 52.4% attended ≥6 well-child visits by the age of 15 months; 60.8% had ≥6 visits by age 2 years. Less than 10% completed 10 vaccination series before their second birthday; with modifications, 36% were up to date. Among children aged 3 to 15 years, 63% had a BMI percentile recorded; 91% had BMI recorded within 36 months of the measurement year.

Conclusions: Applying relevant modifications to national quality measure definitions captured a substantial number of additional services. Strict adherence to measure definitions might miss the true quality of care provided, especially among populations that may have sporadic patterns of care utilization.

Figure 1. Percentage of Children who Received the Recommended Number of Well Child Visits Received by 15 Months of Age Versus 2 Years of Age

Note: The original timeline for having 6 well child visits is before 15 months of age, we modified this timeline to include children up to 2 years of age.

Figure 2. Percentage of Children Up to Date on Each Vaccine Series by Age 2 versus Those Completed by Age 3, Percentage of Adolescents Up to Date by age 13 versus Those Completed by Age 15, and those with Documentation of Parent Refusal

*Up to date – Original timeline means children are up to date with immunizations by age two and adolescents are up to date by age 13. The modified timeline includes children who completed childhood immunizations by age 3 and adolescent immunizations by age 15. Child Immunizations Dtap =Diphtheria, Tetanus, acellular Pertussis IPV=Polio MMR=Measles, Mumps, Rubella Hib=Haemophilus influenza type b Hep B=Hepatitis B VZV=Varicella PCV=Pneumococcal Hep A=Hepatitis A Flu=Influenza Adolescent Immunizations Men=Meningococcal Tdap/Td= Tetanus, Diphtheria acellular Pertussis / Tetanus, Diphtheria booster vaccine

Figure 3. Percentage of BMI Percentile Recorded within 12 Months and within 36 Months of the Measurement Year, by Age

Note: The original timeline is for children/adolecents to have a BMI percentile recorded within the measurement year (12 months) and our modified timeline included children/adolescents that had a BMI percentile recorded within 36 months of the measurement year.