Studies have shown that, on average, patients receive all indicated services only about half the time. A 2007 study found that physicians’ adherence to guidelines for adolescent preventive care fares particularly poorly, meaning that opportunities to prevent the unchecked progression of disease in young people are often missed.
This is especially true with regard to adolescent mental health screening. Despite an overwhelming expert consensus recommending routine adolescent mental health screening, most teens are not offered this service. A survey of family physicians and pediatricians in 2000 found that just 23 percent routinely screen their adolescent patients for mental disorders (Frankenfield et al., 2000).
Quality measurement and reporting can improve care
Health quality measurement and reporting programs, which collect and report information on the rate at which particular services are offered to patients, have been shown to drive improvement in the rate at which patients receive care that meets clinical quality guidelines.
For example, the chart below shows the rate of improvement in providers’ adherence to clinical quality guidelines for four services that are measured and reported on as part of the HEDIS measure set, which is used to evaluate the quality of care provided by health plans.
Reported Improvements to in Adherence to Quality Guidelines for Selected Measures Over Time
Source: National Committee for Quality Assurance (NCQA), State of Health Care Quality, 2004-2009
What is a health quality measure?
According to the Agency for Healthcare Research and Quality (AHRQ), a health quality measure is defined as: “a mechanism used for assessing the degree to which a provider competently and safely delivers clinical services that are appropriate for the patient in an optimal timeframe.”
Quality measures are normally defined as fractions, and a quality measure of the rate of adolescent depression screening might be defined as:
TeenScreen National Center Policy Recommendations
The TeenScreen National Center recommends that a quality measure to assess the rate of adolescent depression screening be included in all quality measure sets used to evaluate the quality of pediatric health care. See the TeenScreen National Center Position Statement on Clinical Quality Reporting.
More specifically, the TeenScreen National Center recommends that a measure of the rate of adolescent depression screening be incorporated into quality reporting sets authorized by the following laws:
CHIPRA of 2009
The Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 called for the identification of a core set of pediatric quality measures for voluntary reporting by state Medicaid and CHIP programs, known as the CHIPRA core set. According to the Centers for Medicaid, CHIP and Survey & Certification (CMCS), “Ultimately, the core measure set will provide an estimate of the overall national quality of health care for children, facilitate comparative analyses across various dimensions of pediatric health care quality, and help identify racial, ethnic and socioeconomic disparities.”
HITECH Act of 2009
Passed as part of the American Recovery and Reinvestment Act (ARRA) of 2009, the HITECH Act also includes significant clinical quality reporting provisions as part of a larger effort to promote the adoption of electronic health records (EHRs) by providers participating in the Medicare and Medicaid programs. The specific health quality measures that must be reported will change over time. However, initial quality reporting requirements, known as Stage 1 Meaningful Use, have been released. Stage 2 and Stage 3 are scheduled to be released in 2012 and 2013, respectively.
Affordable Care Act of 2010
The Patient Protection and Affordable Care Act and the Health Care and Reconciliation Act, together referred to as the Affordable Care Act (ACA), include a number of provisions that will expand health quality measurement and reporting for care provided to youth, such as:
- Pediatric Accountable Care Organizations (Sec. 2706);
- Medical Homes for Medicaid Enrollees with Chronic Conditions (Sec. 2703).