1. Pediatric HCAHPS Measure Development Shanna Shulman, PhD Center of Excellence for Pediatric Quality Measurement

2. Agenda 2  AHRQ/CMS Pediatric Quality Measures Program (PQMP)  Overview of Pediatric HCAHPS development process  Opportunities for involvement in Pediatric HCAHPS development

3. Pediatric Quality Measures Program (PQMP) 3  AHRQ/CMS initiative funded by CHIPRA  To increase the portfolio of evidence-based, consensus- approved 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.

4. PQMP Measure Development Process 4 Step 1: AHRQ/CMS assigns measures to CoEsStep 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

5. Boston Children’s Hospital Center of Excellence for Pediatric Quality Measurement (CEPQM)  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 5

6. PQMP Assignments 6  42 measures assigned across 7 CoEs  http://www.ahrq.gov/CHIPRA 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

7. Consumer Assessment of Healthcare Providers and Systems (CAHPS)  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 7 7

8. CAHPS Family of Surveys  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 8 8

9. Pediatric HCAHPS Measure Overview 9  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 score with composite measures for each survey domain

10. Working Group 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 10

11. CAHPS Survey Design Principles 11  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 11

12. Pediatric HCAHPS Development Sequence  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 12

13. Respondent Perspective  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? 13

14. Core HCAHPS Domains  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

15. Expanded Domains  Hospital Environment  Parent accommodations  Age-appropriate items  Discharge Process  Overall organization  Given information about return to activities  Given information about new medicines 15

16. New Domains 16  Admission process  Care coordination  Family involvement  Cultural competence  Child-appropriateness  Privacy  Safety  Adolescent-specific items 16

17. Sample New Domains  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

18. Sample New Domains (cont.)  Cultural competence  Discrimination  Child appropriateness  Age-appropriate activities available  Privacy  Care and/or treatment plan discussions 18

19. Sample New Domains (cont.)  Safety  Medical mistakes  Adolescent-specific items  Self-care  Involvement in discussions 19

20. Next Steps  Pilot phase  National field test  Case-mix adjustment model  Submission to AHRQ/CMS 20

21. National Field Test 21  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

22. National Field Test Eligibility Criteria 22  Age  Patient 18yrs  Condition  Ineligible: psychiatric, maternity, healthy newborns  Length of Stay  At least one overnight

23. 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

24. Benefits of Joining National Field Test 24  Inform Pediatric HCAHPS development  Initiate Pediatric HCAHPS trend data for your hospital  Contribute to setting national Pediatrics HCAHPS benchmarks

25. Opportunities to Participate 25  Participate in national field test  Contact Shanna Shulman directly at:  shanna.shulman@childrens.harvard.edu shanna.shulman@childrens.harvard.edu  617-919-3550  www.childrenshospital.org/cepqm www.childrenshospital.org/cepqm