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  • Measure Summary
  • NQMC:008306
  • Mar 2012

Pediatrics: percentage of children with a dental health discussion by the 15 month well child visit and/or a referral to a dentist.

Chen AY, Schrager SM, Mangione-Smith R. Quality measures for primary care of complex pediatric patients. Pediatrics. 2012 Mar;129(3):433-45. PubMed External Web Site Policy

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in October 2015.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of children with a dental health discussion by the 15 month well child visit and/or a referral to a dentist.

Rationale

A well-recognized gap exists in assessing and improving the quality of care for United States (U.S.) children. Research findings across various diseases, patient populations, and clinical settings suggest that the quality chasm is pervasive; moreover, concerns regarding the ineffectiveness of traditional models of care are also mounting, particularly for patients with complex medical problems and/or multiple chronic conditions. The Agency for Healthcare Research and Quality has defined complex patients as persons with 2 or more active chronic conditions.

Children with multiple conditions and/or special health care needs are often managed by several providers, including generalists, specialists, and other health professionals. The chronic and complex nature of these conditions, coupled with fragmented interaction and communication across multiple providers, can lead to inconsistent and poorly managed care.

The "patient-centered medical home" (PCMH), defined by the American Academy of Pediatrics (AAP) and other primary care professional organizations as accessible, continuous, comprehensive, family-centered, coordinated, compassionate, culturally effective care, has been adopted as a promising care model for all patients; it is a particularly excellent care model for children with complex conditions and special health care needs. The PCMH is a primary care setting that facilitates partnerships between patients (patients' families) and their physicians. Chen et al (2012) examined evidence for primary care based on the patient- centered medical home model and identified valid and meaningful quality measures for use in complex pediatric patients.

Evidence for Rationale

Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002 Oct 9;288(14):1775-9. PubMed External Web Site Policy

Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA. 1998 Sep 16;280(11):1000-5. [41 references] PubMed External Web Site Policy

Chen AY, Newacheck PW. Insurance coverage and financial burden for families of children with special health care needs. Ambul Pediatr. 2006 Jul-Aug;6(4):204-9. PubMed External Web Site Policy

Chen AY, Schrager SM, Mangione-Smith R. Quality measures for primary care of complex pediatric patients. Pediatrics. 2012 Mar;129(3):433-45. PubMed External Web Site Policy

Frieden TR, Mostashari F. Health care as if health mattered. JAMA. 2008 Feb 27;299(8):950-2. PubMed External Web Site Policy

Hobbs N, Perrin JM, Ireys HT. Chronically ill children and their families. San Francisco (CA): Jossey-Bass Inc, Publishers; 1985.

Houtrow AJ, Kim SE, Chen AY, Newacheck PW. Preventive health care for children with and without special health care needs. Pediatrics. 2007 Apr;119(4):e821-8. PubMed External Web Site Policy

Institute of Medicine, Committee on Quality of Health Care in America. Corrigan JM, et al, editor(s). Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academy Press; 2001. 337 p.

Klerman LV, Perloff JD. Recent trends in the health of US children. In: Stein RE, editor(s). Health care for children-what's right, what's wrong, what's next. New York (NY): United Hospital Fund; 1997.

Managed care and children with special health care needs: a subject review. American Academy of Pediatrics Committee on Children with Disabilities. Pediatrics. 1998 Sep;102(3 Pt 1):657-60. PubMed External Web Site Policy

Mangione-Smith R, DeCristofaro AH, Setodji CM, Keesey J, Klein DJ, Adams JL, Schuster MA, McGlynn EA. The quality of ambulatory care delivered to children in the United States. N Engl J Med. 2007 Oct 11;357(15):1515-23. PubMed External Web Site Policy

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med. 2003 Jun 26;348(26):2635-45. PubMed External Web Site Policy

Medical Home Initiatives for Children With Special Needs Project Advisory Committee, American Academy of Pediatrics. The medical home. Pediatrics. 2002 Jul;110(1 Pt 1):184-6. PubMed External Web Site Policy

Newacheck PW, Stein RE, Walker DK, Gortmaker SL, Kuhlthau K, Perrin JM. Monitoring and evaluating managed care for children with chronic illnesses and disabilities. Pediatrics. 1996 Nov;98(5):952-8. PubMed External Web Site Policy

Reed MC, St. Peter RF. Satisfaction and quality: patient and physician perspectives. Washington (DC): Center for Studying Health System Change; 1997.

Schuster MA, McGlynn EA, Brook RH. How good is the quality of health care in the United States. Milbank Q. 1998;76(4):517-63, 509. [75 references] PubMed External Web Site Policy

Special emphasis notice: AHRQ announces interest in career development (K) grants focused on prevention and healthcare management of complex patients. Notice number: NOT-HS-08-004. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Dec 14 [accessed 2008 Oct 06].

Primary Health Components

Well child visit; dental health; referral to dentist; children

Denominator Description

Number of children under 15 months of age

Numerator Description

Number of children with a dental health discussion OR a referral to a dentist (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • Focus groups
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

  • There is broad consensus on the emerging need to provide patient- and family-centered care; for example, researchers have noted with concern the rarity with which patient and family perspectives are considered valid evidence to inform quality measures or guidelines, and the American Academy of Pediatrics (AAP) has explicitly urged pediatricians to establish partnerships with families of medically complex children in planning and executing care.
  • Chronic diseases represent perhaps the largest burden on our health care system today. Unlike care for acute illnesses, which is usually contained in a finite number of visits, medical care for chronic illnesses is a long-term process that requires multifaceted care. Wagner and colleagues commented that the needs of patients with chronic illnesses are unlikely to be met by an acute care system.
  • Coordination of care is also an important component of care for clinically complex patients. A recent Commonwealth Fund report suggested a "roadmap" for coordination of care, advocating that it should be proactive, planned, comprehensive, support/rely on team care, and jointly developed (with patient/family) to ensure effective communication and collaboration.
  • For chronically ill children, another facet of care involves prevention and health maintenance.

Evidence for Additional Information Supporting Need for the Measure

Antonelli R, McAllister J, Popp J. Making care coordination a critical component of the pediatric health system: a multidisciplinary framework. New York (NY): The Commonwealth Fund; 2009.

Bodenheimer T, Chen E, Bennett HD. Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job. Health Aff (Millwood). 2009 Jan-Feb;28(1):64-74. PubMed External Web Site Policy

Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002 Oct 16;288(15):1909-14. PubMed External Web Site Policy

Chen AY, Schrager SM, Mangione-Smith R. Quality measures for primary care of complex pediatric patients. Pediatrics. 2012 Mar;129(3):433-45. PubMed External Web Site Policy

Krahn M, Naglie G. The next step in guideline development: incorporating patient preferences. JAMA. 2008 Jul 23;300(4):436-8. PubMed External Web Site Policy

Palfrey JS, Sofis LA, Davidson EJ, Liu J, Freeman L, Ganz ML, Pediatric Alliance for Coordinated Care. The Pediatric Alliance for Coordinated Care: evaluation of a medical home model. Pediatrics. 2004 May;113(5 Suppl):1507-16. PubMed External Web Site Policy

Rothman AA, Wagner EH. Chronic illness management: what is the role of primary care?. Ann Intern Med. 2003 Feb 4;138(3):256-61. [56 references] PubMed External Web Site Policy

Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511-44. [121 references] PubMed External Web Site Policy

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Patient-centered Medical Homes

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age less than 15 months

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of children under 15 months of age

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of children with a dental health discussion* OR a referral to a dentist

*Operationalized as timing of visiting a dentist or instructions on brushing or flossing.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

Internal time comparison

Original Title

The primary care team should document a discussion with parents about the child's dental health and/or referral to a dentist by the 15 month well child visit.

Measure Collection Name

Quality Measures for Primary Care of Complex Pediatric Patients

Measure Set Name

Primary Care

Submitter

Chen, Alex, MD, MS; Schrager, Sheree, MS, PhD; Mangione-Smith, Rita, MD, MPH - Independent Author(s)

Developer

Chen, Alex, MD, MS; Schrager, Sheree, MS, PhD; Mangione-Smith, Rita, MD, MPH - Independent Author(s)

Funding Source(s)

Dr. Chen was supported by the Agency for Healthcare Research and Quality (AHRQ) grant 5K02HS018087 during the study period.

Composition of the Group that Developed the Measure

Alex Y. Chen, MD, MS (Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, Los Angeles, California); Sheree M. Schrager, MS, PhD (Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, Los Angeles, California); Rita Mangione-Smith, MD, MPH (Center for Child Health, Behavior, and Development, Seattle Children's Hospital Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington)

Financial Disclosures/Other Potential Conflicts of Interest

The authors have indicated they have no financial relationships relevant to this article to disclose.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2012 Mar

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in October 2015.

Source(s)

Chen AY, Schrager SM, Mangione-Smith R. Quality measures for primary care of complex pediatric patients. Pediatrics. 2012 Mar;129(3):433-45. PubMed External Web Site Policy

Measure Availability

Source available from the American Academy of Pediatrics (AAP) Web site External Web Site Policy.

For more information, contact Alex Chen, MD, MS, at AltaMed Health Services, 2040 Camfield Ave, Los Angeles, CA 90040; Phone: 562-659-2821; E-mail: alexchen_y@yahoo.com External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on July 8, 2013. The information was verified by the measure developer on July 29, 2013.

The information was reaffirmed by the measure developer on October 16, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the American Academy of Pediatrics (AAP) copyright restrictions.

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