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Table 1 Calculation of Proposed Quality Measures for Children in Foster Care within an EHR: Proportion Measures

From: Health care quality measures for children and adolescents in Foster Care: feasibility testing in electronic records

Measure

Numerator

Denominator

Guideline(s) Referenced

Notes

Young children (age 0–3 years)

 1st well-care visit within 30 days of initial entry into foster care

Children with a first well-care visit within 30 days of entry

All children with an exact date or date range of entry into foster care

Health Care of Young Children in Foster Care [23]

Only children with an exact date or date range of initial entry into foster care are included in the denominator

 Appropriate number of well care visits for their age during foster care

Children who received all recommended well-care visits for their age during foster care

All children

Recommendations for Preventive Pediatric Health Care [24]

Well-care visits were not required to occur within any particular window of time around the exact ages of recommended well-care visits

 Appropriate number of vaccinations by age 1

Children with all recommended vaccinations received by 1 year of age, whether received while in foster care or not

All children who turned 1 year of age while in foster care

CDC 2013 Immunization Schedules [32]

HEDIS Childhood

HEDIS requirements for the appropriate timing of vaccines as specified for their Combination #2 measure were followed. Only those vaccinations that are supposed to occur by age 1 were included (i.e. DTaP, IPV, HiB and HepB)).

Immunization Status [29]

 Appropriate number of vaccinations by age 2

Children with all recommended vaccinations received by 2 years of age, whether received while in foster care or not

All children who turned 2 years of age while in foster care

CDC 2013 Immunization Schedules [32]

HEDIS Childhood

HEDIS requirements for the appropriate timing of vaccines as specified for their Combination #2 measure were followed. Only those vaccinations that are supposed to occur by age 2 were included (i.e. DTaP, IPV, HiB, HepB, MMR and VZV)

Immunization Status [29]

 Appropriate number of lead screenings for their age during foster care

Children who received the appropriate number of lead screenings while in foster care

All children who turned 1 year and/or 2 years of age while in foster care

Guidelines for Medicaid Lead Testing [33]

Screenings had to occur during the following age periods, if the child was in foster care at age 1 year and 2 years respectively: 9–21 months of age and 22–36 months of age

 Appropriate number of developmental screenings for their age during foster care

Children who received all recommended developmental screenings for their age during foster care

All children

Recommendations for Preventive Pediatric Health Care [24]

Screenings were not required to occur within any particular window of time around the exact ages of recommended screenings. Documentation that a specific standardized tool used was not necessary; any mention of a developmental screening was included.

 Developmental screening during foster care within 3 months after documentation of traumatic brain injury (TBI)

Children who received a developmental screening within 3 months after documentation of TBI

All children diagnosed with a TBI prior to entry into foster care

Evaluation of suspected child physical abuse [21]

A 3 month window was used based on professional medical opinion

Head Injury. Triage, Assessment, Investigation and Early Management of Head Injury in Infants, Children and Adults [13]

 Follow up skeletal survey after receiving an initial skeletal survey

Children who received a follow up skeletal survey

All children who received an initial skeletal survey

Evaluation of suspected child physical abuse [21]

The follow up skeletal survey was not required to occur within any certain period of time after the initial skeletal survey

 Care coordination letters at foster home changes

Instances of foster home changes that had evidence of a care coordination letter

All documented foster home changes

Health Care of Young Children in Foster Care [23]

 

Adolescents (age 12–18 years)

 Appropriate number of well care visits during foster care

Adolescents who received all recommended annual well-care visits during foster care

All adolescents

Recommendations for Preventive Pediatric Health Care [24]

For every portion of a year that a child spent in foster care, whether that time was continuous or not, at least one well care visit should have occurred

 Appropriate adolescent immunizations

Adolescents who received at least one TdaP vaccination on or after their 10th birthday but before their 19th birthday and at least one Meningococcal vaccination on or after their 11th birthday but before their 19th birthday, whether received while in foster care or not

All adolescents

CDC 2013 Immunization Schedules [32]

TdaP or Td vaccinations both counted towards this measure

HEDIS Adolescent Immunization Measure [29]

 Three Human Papilloma Virus (HPV) vaccinations in females

Three Human Papilloma Virus (HPV) vaccinations on or after the 9th birthday but before the 13th birthday, whether received while in foster care or not

Females only

HEDIS Human Papillomavirus Vaccine for Female Adolescents Measure [29]

 

 Appropriate number of BMI measurements

Adolescents who received all recommended annual BMI measurements during foster care

All adolescents

Recommendations for Preventive Pediatric Health Care [24]

For every portion of a year that a child spent in foster care, whether that time was continuous or not, at least one BMI measurement should have occurred

 Appropriate number of drug use assessments

Adolescents who received all recommended annual drug use assessments during foster care

All adolescents

Recommendations for Preventive Pediatric Health Care [24]

For every portion of a year that a child spent in foster care, whether that time was continuous or not, at least one drug use assessment should have occurred

 Appropriate number of alcohol use assessments

Adolescents who received all recommended annual alcohol use assessments during foster care

All adolescents

Recommendations for Preventive Pediatric Health Care [24]

For every portion of a year that a child spent in foster care, whether that time was continuous or not, at least one alcohol use assessment should have occurred

 Appropriate number of sexually transmitted infection screenings

Adolescents who received all recommended annual chlamydia and gonorrhea screenings during foster care

All adolescents

Recommendations for Preventive Pediatric Health Care [24]

For every portion of a year that a child spent in foster care, whether that time was continuous or not, at least one chlamydia and at least one gonorrhea screening should have occurred

 Appropriate number of depression screenings

Adolescents who received all recommended annual depression screenings during foster care

All adolescents

Recommendations for Preventive Pediatric Health Care [24]

For every portion of a year that a child spent in foster care, whether that time was continuous or not, at least one depression screening should have occurred