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

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.

Measuring Prevention More Broadly: An Empirical Assessment of CHIPRA Core Measur

“…While electronic health record (EHR) data might be suitable to this task (Casciato et al, 2012;Gold et al, 2012), not all states or programs may have the resources that this requires. Thus, understanding the limitations of how claims data are used to calculate CHIPRA quality measures is important if the measures are to be used in research and policy decisions.…”

Variation in Outcomes of Quality Measurement by Data Source

“…However, limitations to using administrative claims data for such purposes have been shown in previous research assessing care quality. [10][11][12][13] Although adding data from discreet electronic health record (EHR) data fields shows promise in improving the accuracy of claims-based quality measurement, 11,14,15 assessments using EHR data alone may have limitations. [16][17][18] For example, in a study of the quality of care provided to adults with diabetes, neither Medicaid administrative claims nor EHR data alone yielded a complete capture of provided services: 12% of cholesterol screenings received were documented in Medicaid claims but not the EHR, 49% were documented in the EHR but not in Medicaid claims, and only 39% were documented in both data sources.…”

“…[16][17][18] For example, in a study of the quality of care provided to adults with diabetes, neither Medicaid administrative claims nor EHR data alone yielded a complete capture of provided services: 12% of cholesterol screenings received were documented in Medicaid claims but not the EHR, 49% were documented in the EHR but not in Medicaid claims, and only 39% were documented in both data sources. 10 After the CHIPRA measures were initially developed, Gold et al 12 determined which of these claims-based measures could feasibly be calculated by using electronically abstracted EHR data, and what modifications to the claims-based technical specifications were needed, if any, to enable such EHR-based measurement. Building directly on that landmark study, the present analysis sought to evaluate the accuracy of selected CHIPRA claims-based measures, when based on administrative claims data alone, EHR data alone, or both data sources combined.…”

Variations in Measurement of Sexual Activity Based on EHR Definitions

“…Traditionally, performance measures have been calculated from administrative claims data, medical record review, or a combination of the 2, with varying results. [1][2][3][4] The introduction of electronic health record (EHR) systems to manage clinical information has spurred a national movement toward using these systems for performance measurement. [5][6][7][8][9][10][11][12][13] Similarly, federal government efforts are encouraging quality measurement and use of health information technology in the area of pediatric and adolescent health care.…”

“…Recent studies have shown some promise toward this end. 4,33,34 Gold et al 4 demonstrated that using EHRderived social history information improved the accuracy of a Chlamydia screening measure compared with claims-based information. The study, however, did not assess the validity of the definition of sexual activity used in the denominator of their measure, which has prompted some criticism about the application of their approach to health care quality measurement.…”