Measurement work

5/15/24

1. June didactic with Renee/Nita on nurse visit follow ups for BMI

1. Huddle will AAP in June re: measures

CMS Open Requirements for Measures Testing

CMS replaced the NQF measure endorsement process starting in 2023 with a new "consensus-based entity" . The contract was awarded to Batelle...and they call the new entity the "Partnership for Quality Measurement". The intent of replacing/revising the process was  for it to be more transparent, efficient, and far less resource-intensive. Sounds good, right? Right. 

Here's what I've found so far:

Webpage: https://p4qm.org

Webpage on Endorsement & Maintenance: https://p4qm.org/EM

Guidebook on Endorsement & Maintenance: https://p4qm.org/sites/default/files/2023-12/Del-3-6-Endorsement-and-Maintenance-Guidebook-Final_0_0.pdf

Guidebook pages 19-20 describe the process, and 37-46 give the measure "evaluation rubric". This is VERY helpful to see laid out.  

Example of a measure (HIV, not totally relevant, but helpful to see): https://p4qm.org/measures/3210e

1. Next steps:

Get chart developed for what we have, what we need

AC to send around a stakeholder list for July convening

P4qm to engage to engage and inform the process

Invite NCQA to join a call (no money involved)

Look for outside funding

3/20/24

1. Measurement work

   1. All health centers provided AIM statements

2. Micronutrients

   1. Looking at iron/ferritin

   2. 26000 dyads (mom/baby) identified

3. Data set from last year---stratification of weight classifications--peer review publication in process

4. Not all EMRs have the most updated growth charts, etc..

Next steps:

1. Align work with Azara with what Meg is doing….one approach--NACHC

2. a. Waiting on CPG around iron screening. In health centers, are finding anemia at high rates b. Mother-child linkage (26,000!) data to be explored. Long term looking at iron levels, also lead, etc… esp around immigrant pops

3. Nita to send spreadsheet of classifications

4. Nita to send names of EMRs not in compliance to Aly.

1/17/24

1. Update to quality measure testing

2. Micronutrients

1. a. Include Lipids, diabetes labs etc on the measure. Aligns with CPGs. Feedback was good for feasibility. b. Questions about BP measure---right now done only at well-child visits, not other ones. Exploring whether it’s helpful….interpretation of BPs that are being taken is not being done. So not being included in this year. c. Follow-up--having kids with any abnormal BMI needs to be followed up, not just at Well Child visit and not as a “weight check”. This year, the recommendation will be b/w 4-16 weeks, and at index visits (where BMI is id), a SMART goal is set. Follow-up visits will surround the SMART goal. SMART tools will be developed, this is beyond counseling.

Cohort now includes HI and NYC (Settlement Health residency), rural Illinois, urban Illinois, Utah (HC Homeless), investigating El Rio

Talking to Azara about building these measures in to Azara. First step will be with this cohort, then meet with measures folks at CDC (PHII), then spread/scale with NACHC/Azara

Curbside: Website version to be used as a adjunct tool for participants to use. Exploring what an integration looks like? Piloting with Athena.

2. Micronutrients---data being shared, working on DUA with CDC

3. Dissemination: publishing--1) engaging stakeholders; 2) Comparisons NHANES; disparity in stratification (race/ethnicity)

Will apply to NACHC, AAP Obesity, PCA meetings, World Nutrition and Obesity Congress, CDC Public Health Informatics?? , CDC Participant training in May??

11/15/23

1. Planning for Lab Screening Measure Scale and Spread

2. Planning for Follow Up QI Collaborative in Primary Care

3. Dissemination and Data Analyses follow up

4. Brief update on Micronutrients work

1. Nita to join Legacy Call in December to briefly orient them to this work. Launch call and orientation in January. Sarah Price to update Jessica Wallace (SME/Legacy Team lead) to this work and coordinate. Perhaps develop a more simple guide with Mona/Sara Barlow, clinicians to talk this through--lab quality measure vs. screening vs. diagnostic ---elevated levels ONCE are not diagnostic…they are screening that leads to more exploration. How it compares to the algorithm. --Do a mini convening in December with folks . Other linkages: Million Hearts--Sarah talk to Meg about the familial hypercholesterolemia. Pediatricians in Clinical Practice Committee---a solidified ask to go out to CPC.

2. Launch in January--by the next meeting, a proposed workflow and MI intervention from AAP toolkit will be shared on this call.

3. a. AAP conference poster--very successful. b. Possible work with Puerto Rico on food insecurity. c. Next up: Standard Slide Deck content--Nita to send data spreadsheet

10-18-23

1. Year 6 Obesity Related activities overview (Analyses, QI collaboratives, Measures work, MOC, Collaborations with PHII and AAP)

2. AC Dissemination Focus: AAP meeting, planned publications

3. Brief update on Micronutrients work

1. Y5 48 to 62% improvement within the cohort--NACHC/CDC to create a formal letter of congratulation--Nita will draft, send to CDC to formalize

Y6, focus on reworking the follow-up workflow instead of focus on screening. Continue screening MOC. Based on AAP guidelines and instructions. Include Motivational Interviewing/culture. Focus in NOT on a MEASURE, but rather on Quality Improvement.

OR

More work on Lab measure--goal is to scale it to more practice settings to prove to CMS? Maybe test this in Denver Health, Missouri, rather than through the cohort, Boriquien, El Rio. Pressure from CMS to get this quality measure in place.

From AAP:

Just sharing the link to the Treatment Flow which has specific guidance that the sites in our QI projects and ECHOs have found helpful: https://downloads.aap.org/AAP/PDF/Obesity/Treatment%20Flow_12.19.22.pdf  See below for relevant experts that address the frequency, timing and key operations. Also the QI package has additional resources and supports (it can be found at the bottom of left of this section of the CPG site). The key driver diagram (found within the QI resources) is also helpful  in outline key elements, change concepts and resources to support the treatment visits.