Appendix D

Summary of Performance Measurement Topics Used across Seven Child Health Programs Involving Federal Funding

The seven child health programs involving federal funding include

1. Child Welfare [Administration for Children and Families] (CW)
2. Early Intervention [U.S. Department of Education] (EI)
3. Federally Qualified Health Centers [Health Resources and Services Administration] (FQHC)
4. Healthcare Effectiveness Data and Information Set (managed care organization measures) [National Committee for Quality Assurance] (HEDIS)
5. Maternal, Infant, and Early Childhood Home Visiting [Health Resources and Services Administration] (HV)
6. Medicaid and Children’s Health Insurance Program (CHIP) [Centers for Medicare & Medicaid Services] (MCD)
7. Title V [Health Resources and Services Administration] (TV).

For each measurement topic, the number of measures used and names of agencies by code above with measures on this topic used as of 2022 are included in parentheses. This analysis was conducted by the Child and Adolescent Health Measurement Initiative (CAHMI) using information from the CAHMI Maternal and Child Health Measurement Compendium database.¹ This analysis was conducted to inform the formulation of the Engagement In Action Framework (EnAct!) for integrated child health systems (Bethell et al., 2023b).

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¹ See https://www.cahmi.org/our-work-in-action/measurement-in-action/compendium

Measurement topics that address insurance, access, and utilization include 12 topics with a total of 38 measures.
Six of 12 topics (50%) are used for two or more programs/measurement sets.

1. Adolescent well visits (4/TV, MCD, HEDIS)
2. Infants and toddlers with an individualized family services plan (IFSP) (2/EI)
3. Services were delivered in a home or community setting (1/EI)
4. Child and adolescent health insurance coverage, continuity and/or adequacy (3/TV, HV)
5. Outpatient visits, including telehealth (1/HEDIS)
6. Timely receipt of services for infants and toddler with an IFSP (2/EI)
7. Children and adolescents who are uninsured (1/TV)
8. Prenatal and postpartum care (6/TV, MCD, FQHC, HV, HEDIS)
9. Well-child visits (7/TV, HV, MCD, HEDIS)
10. Children and adolescents who did not receive needed health care (1/TV)
11. Receipt of dental care services (8/MCD, TV, FQHC, HEDIS)
12. Well-woman visits (3/TV, MCD, HEDIS)

Measurement topics that address quality of care, including screenings, referrals, and follow-ups include 17 topics with a total of 70 measures.
Nine of 17 topics (52.9%) topics are used for two or more agencies.

1. Behavioral concerns of children (1/HV)
2. Early childhood developmental screening (6/TV, MCD, HV)
3. Parent–child interactions assessment (1/HV)
4. Cervical cancer screening (4/HEDIS)
5. Follow-up after hospitalization for mental illness (12/MCD, HEDIS)
6. Social needs follow-up (e.g., food security, housing) (3/HEDIS)
7. Chlamydia screening (2/MCD, HEDIS)
8. Follow-up care for prescribed medication for attention deficit hyperactivity disorder (ADHD) (6/MCD, HEDIS)
9. Social needs screening (e.g., food security, housing) (3/HEDIS)
10. Completed depression referrals (5/HEDIS, HV, FQHC)
11. Intimate partner violence referrals (1/HV)
12. Tobacco, alcohol, or other drug cessation referrals/treatments for adults and/or caregivers (7/FQHC, MCD, HEDIS)

13. Completed developmental status referrals (1/HV)
14. Intimate partner violence screening (1/HV)
15. Tobacco, alcohol, or other drug screening (2/FQHC, HV)
16. Depression screening (13/FQHC, TV, MCD, HV, HEDIS)
17. Lead screening (2, MCD, HEDIS)

Measurement topics that address quality of care, including the care process, education, and counseling include 11 topics with a total of 52 measures.
Six of 11 topics (54.5%) are used for two or more measurement sets.

1. Antibiotic treatment (4/HEDIS)
2. Contraceptive care (6/HEDIS)
3. Transition of care (adolescents, early intervention) (2/TV, EI)
4. Asthma medication (2/MCD, HEDIS)
5. Labor and delivery care (4/TV, MCD)
6. Use of first-line psychosocial care for children and adolescents (2/MCD, HEDIS)
7. Children and adolescents receiving care in a setting that meets multipart medical home measure (2/TV)
8. Mediated dispute resolution (2/EI)
9. Weight assessment, counseling for nutrition, physical activity (9/FQHC, MCD, HEDIS)
10. Consumer assessment of health care providers and systems health plan—includes several experience-of-care measures (4/MCD, HEDIS)
11. Monitoring of children and adolescents on antipsychotics (15/MCD, HEDIS)

Measurement topics that address health-related and intermediate outcomes include 31 topics with 148 measures.
Seven of 31 (22.6%) topics are used for two or more measurement sets.

1. Bullying (victimization or perpetration) (3/TV)
2. Children and adolescents with a mental or behavioral condition who receive treatment or counseling (1/TV)
3. Low birth weight (4/TV, HV, MCD)
4. Child and adolescent immunization status (60/FQHC, TV, MCD, HEDIS)
5. Children and adolescents with special health care needs (CSHCN) (1/TV)
6. Maternal mortality rate (1/TV)

7. Child and adolescent mortality rates, including suicide, motor vehicle accidents (4/TV)
8. Children and adolescents with special health care needs who receive care in a well-functioning system (1//TV)
9. Mental health disorder diagnosis (5/HEDIS)
10. Child and adolescent physical activity (3/TV)
11. Early/infant death mortality rates (6/TV)
12. Mothers breastfeeding (3/TV, HV)
13. Child maltreatment (3/HV, CW)
14. Early language and literacy activities or caregivers (e.g., daily reading) (1/HV)
15. Prenatal immunization status (3/HEDIS)
16. Child socioemotional knowledge, skills, and behavior (1/EI)
17. Emergency department visits and injury hospitalizations (4/TV, MCD, HV)
18. Preterm birth (2/TV, HV)
19. Children and adolescents diagnosed with attention deficit disorder or ADHD (1/TV)
20. Families using infant safe-sleep methods (4/TV, HV)
21. Primary caregiver education (1/HV)
22. Children and adolescents diagnosed with an autism spectrum disorder (1/TV)
23. Family knowledge of rights, communicating child’s needs, and supporting development (1/EI)
24. Severe maternal morbidity (1/TV)
25. Children and adolescents in excellent or very good health (1/TV)
26. Foster-care related outcomes (e.g., timely placement) (23/CW)
27. Smoking/tobacco use (2/TV)
28. Children and adolescents who are obese (3/TV)
29. Infants born with alcohol or substance exposure (neonatal abstinence) (2/TV)
30. Teen birth rate (1/TV)
31. Children and adolescents who have decayed teeth or cavities (1/TV)

NOTE: New Title V national outcomes measures starting in 2024 will include school readiness, child flourishing, two or more adverse childhood experiences, housing instability, food insecurity, and more.