Transcript Overview of Brand Strategy - Boston Children's Hospital

Pediatric HCAHPS Measure
Development
Shanna Shulman, PhD
Center of Excellence for Pediatric Quality Measurement
Agenda
2

AHRQ/CMS Pediatric Quality Measures Program (PQMP)

Overview of Pediatric HCAHPS development process

Opportunities for involvement in Pediatric HCAHPS
development
Pediatric Quality Measures Program (PQMP)
3

AHRQ/CMS initiative funded by CHIPRA
 To
increase the portfolio of evidence-based, consensusapproved pediatric quality measures available to public
and private purchasers, providers, and consumers

$55M effort over 4 years (2011-2015)

7 Centers of Excellence (CoEs) funded across U.S.
PQMP Measure Development Process
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Step 1: AHRQ/CMS assigns measures to CoEs
Step 2: CoEs develop and test measures
Step 3: CoEs deliver final measures with support
materials to AHRQ/CMS
Step 4: AHRQ/CMS Expert Panel reviews measures
Step 5: AHRQ/CMS makes measures available for
state Medicaid/CHIP reporting and for general use
Boston Children’s Hospital Center of Excellence
for Pediatric Quality Measurement (CEPQM)
5

Leadership
 Director:
Mark Schuster, MD, PhD
 Managing Director: Shanna Shulman, PhD

Advisory groups
 Scientific
Advisory Board
 National Stakeholder Panel
 Massachusetts Child Health Quality Coalition

Working groups develop and test assigned measures
PQMP Assignments
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
42 measures assigned across 7 CoEs
 http://www.ahrq.gov/CHIPRA

CEPQM round 1 assignments
 Pediatric
readmissions
 Inpatient family experience of care (Pediatric HCAHPS)

CEPQM round 2 assignments
 Transition
from child-focused to adult-focused care
 Access to disability support services
 Global tool of patient safety
Consumer Assessment of Healthcare
Providers and Systems (CAHPS)
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


Public-private initiative to develop standardized
surveys of patients’ experiences of care funded by
AHRQ and CMS
Gold standard in the field – launched in mid-1990s
Health care organizations, public and private
purchasers, consumers, and researchers use CAHPS
results to:
 Assess
the patient-centeredness of care
 Compare and report on performance
 Improve quality of care
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CAHPS Family of Surveys
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
Facility care
Hospital Survey
 In-Center Hemodialysis Survey
 Nursing Home Surveys (Resident and Family)


Ambulatory care
Health Plan Survey*
 Clinician & Group Survey*
 Surgical Care Survey
 ECHO Survey (Behavioral Health)
 Dental Plan Survey
 American Indian Survey
 Home Care Survey
 PCMH Survey*

*Pediatric version available
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Pediatric HCAHPS Measure Overview
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
CAHPS approach
 Collaborating
with the CAHPS team
 Following HCAHPS design principles
 Will be a part of the CAHPS family of measures

Final measure specification
 Global
domain
score with composite measures for each survey
Working Group
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PI: Mark Schuster, MD, PhD (Boston Children’s Hospital)
Patricia Branowicki, MS, RN (Boston Children’s Hospital)
Julie Brown, BA (RAND)*
Paul Cleary, PhD (Yale School of Public Health)*
Marc Elliott, PhD (RAND)*
Jack Fowler, PhD (Univ. Massachusetts Boston)*
Patricia Gallagher, PhD (Univ. Massachusetts Boston)*
Dale Shaller, MPA (Shaller Consulting)*
Susan Shaw, MSN, MS, RN (Boston Children’s Hospital)
Shanna Shulman, PhD (Boston Children’s Hospital)
Sara Toomey, MD, MPH, MPhil, MSc (Boston Children’s Hospital)
Alan Zaslavsky, PhD (Harvard Medical School)*
*Member of the CAHPS Consortium
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CAHPS Survey Design Principles
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
Emphasis on patients
What patients value
 Aspects of care for which patients are generally the best or
only source of information
 Extensive testing with patients and families


Standardization to support valid comparisons and
benchmarking
Survey instruments
 Data collection
 Analysis
 Reporting


All CAHPS surveys and products are in the public domain
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Pediatric HCAHPS Development Sequence
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
Pre-pilot phase
Literature and measures review
 Expert interviews
 Federal Register Notice released
 Focus groups in English and Spanish nationally
 Draft candidate items
 Cognitive interviews in English and Spanish nationally
 Finalize draft instrument


Pilot phase
National field test (including summer pilot)
 Case-mix adjustment model
 Submission to AHRQ/CMS

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Respondent Perspective
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

Parent/guardian survey
Most items reflect parents’ experiences of their
child’s hospitalization
 During
this hospital stay, how often did your child’s
doctors listen carefully to you?

A few items reflect parent-report of their child’s
experience of care during the hospitalization
 During
this hospital stay, how often did your child’s
doctors listen carefully to your child?
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Core HCAHPS Domains
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







Communication with doctors and nurses
Responsiveness of hospital staff
Pain management
Communication about medicines
Discharge information
Hospital environment (i.e., cleanliness, quietness)
Overall hospital rating
Demographics
14
Expanded Domains
15

Hospital Environment
 Parent
accommodations
 Age-appropriate items

Discharge Process
 Overall
organization
 Given information about return to activities
 Given information about new medicines
15
New Domains
16








Admission process
Care coordination
Family involvement
Cultural competence
Child-appropriateness
Privacy
Safety
Adolescent-specific items
16
Sample New Domains
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
Admission process
 Admission
through the ER
 Kept informed about next steps
 Asked about medications

Care coordination
 Providers

kept up-to-date
Family involvement
 Value
your knowledge as a parent
 Involvement in discussions
17
Sample New Domains (cont.)
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
Cultural competence
 Discrimination

Child appropriateness
 Age-appropriate

activities available
Privacy
 Care
and/or treatment plan discussions
18
Sample New Domains (cont.)
19

Safety
 Medical

mistakes
Adolescent-specific items
 Self-care
 Involvement
in discussions
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Next Steps
20

Pilot phase
 National
field test
 Case-mix
adjustment model
 Submission
to AHRQ/CMS
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National Field Test
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
Field period
 Fall

2012 with 6-9 months data collection
Recruitment goal
 30-50

hospitals nationwide
Administration
 CAHPS
mail and phone survey protocol
 CAHPS-approved vendors
National Field Test Eligibility Criteria
22

Age
 Patient

< 18yrs AND Parent/Guardian > 18yrs
Condition
 Ineligible:

psychiatric, maternity, healthy newborns
Length of Stay
 At
least one overnight
National Field Test Timeline
23

National field test (November 2012–Summer 2013)
National field test (target: 30-50 hospitals)
 Data submission periods in February, May, and end of summer
 Hospitals may continue using instrument beyond field test period


Analysis & measure specification (Fall 2013–Winter 2014)
Psychometric testing, composite analysis
 Case-mix analysis
 Measure specification


AHRQ Review (Summer 2014 – Fall 2014)

AHRQ approval as “PQMP” measure
Benefits of Joining National Field Test
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


Inform Pediatric HCAHPS development
Initiate Pediatric HCAHPS trend data for your
hospital
Contribute to setting national Pediatrics HCAHPS
benchmarks
Opportunities to Participate
25

Participate in national field test

Contact Shanna Shulman directly at:
 [email protected]
 617-919-3550
 www.childrenshospital.org/cepqm