Development of a pediatric quality measure set for the military health system

Abstract

Background:

The Military Health System (MHS) is an integrated health care system composed of direct care and purchased care that serves over 9.4 million beneficiaries including 2 million children. The current MHS quality measures dashboard includes few measures specific to children and may not reflect the needs of military children.

Methods:

Internal stakeholders across the MHS were engaged, including pediatric leads for Army, Navy, Air Force and the National Capital Region and as well as federal interagency experts from multiple agencies (e.g. AHRQ, CDC, CMS, HRSA, and SAMHSA) in a collaborative systematic, evidence-informed process to develop a framework and core set of prioritized pediatric measures for implementation. Multiple meetings were convened to identify and consider dimensions essential for a pediatric dashboard. Elements considered include: health care domains; measure concepts, and measure specifications for pediatric health care quality that had potential to address MHS system-level needs. Measures were selected and prioritized primarily through iterative expert reviews using a defined measure prioritization framework. Participants were provided with a set of criteria, informed by published approaches used in the selection of national quality measures. Each iteration of review resulted in the narrowing of measures for consideration removing those deemed aspirational, posing implementation challenges, requiring further testing and validation, not aligning with MHS priorities, and/or viewed as less valuable with regard to their potential impact to improve health care delivery and outcomes of the MHS pediatric population.

Findings:

The final result is a consensus-based core set of 26 quality measures for implementation that is tailored to the unique needs of the MHS pediatric population. During the process, new methodology for measures selection, a pediatric quality measure framework and an inventory of pediatric health care performance measures were also developed.

Implications for D&I Research:

The MHS engaged in a novel systematic, data driven, evidence informed process that used active stakeholder engagement from project onset through its conclusion to align core measures with existing system-level needs and health care priorities of military children. Our evidence informed process of measures selection is generalizable to other integrated health care systems.