Real-World Considerations for Implementing Pediatric Quality Measures: Insights From Key Stakeholders

Abstract

Objective: Since its inception, the Pediatric Quality Measures Program has focused on the development and implementation of new and innovative pediatric quality measures (PQM) for both public and private use. Building the evidence base related to measure usability and feasibility is central to increasing measure uptake and, thereby, to increased performance monitoring and quality improvement (QI) for children in Medicaid or the Children's Health Insurance Program. This paper describes key stakeholder insights focused on measure implementation and increasing the uptake of PQM.

Methods: The PQMP Learning Collaborative conducted semistructured interviews with 9 key informants (KIs) representing states, health plans, and other potential end users of the measures. The interviews focused on gaining KIs' perspectives on 6 research questions focused on assessing the feasibility and usability of PQM and strengthening the connection between measurement and improvement.

Results: Our synthesis identified insights that highlight facilitators and barriers from the KIs' experience and the strategies they employ when using measures to drive improvement "on-the-ground." Importantly, while the KIs agreed on how essential the research questions are to measure implementation and uptake, they uniformly acknowledged the complexity of the issues raised and pinpointed multiple unresolved issues.

Discussion: The views expressed by these stakeholders point to several key issues - including incorporation of socio-economic status into quality measures and performance comparisons, use of benchmark data, and criteria for QI versus accountability - for developing a real-world research agenda to guide the future direction of quality measurement and implementation to improve children's health care.

Keywords: measure implementation; pediatrics; quality measures.