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UF Health research team receives funding to improve health care for children in Medicaid, CHIP

UF Health researchers have received a grant to use big data analytics to improve health care for children in Medicaid and Children’s Health Insurance Programs in Florida and Texas.

Through funding from the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services, the UF Health team will serve as one of six Pediatric Quality Measures Programs. The programs will focus on testing and implementing new pediatric quality measures developed by the PQMP Centers of Excellence.

Quality measures are used to evaluate or quantify specific health care processes, outcomes or other factors related to health-care delivery. Specifically, the pediatric quality measures are used by state Medicaid and CHIP to measure and improve the quality of children’s health care.

“With this study, we are harnessing the power of pediatric big data to make substantive improvements in the health of children,” said Elizabeth A. Shenkman, chair of the department of health outcomes and policy at the UF College of Medicine, the grant’s principal investigator and national co-chair of the Patient-Centered Outcomes Research Institute’s PCORnet Pediatrics Collaborative Research Group. “These measures ensure children in Medicaid and CHIP receive the highest quality of care.”

The UF Health research team will focus on two measures: preventive oral health care, and the safe and judicious use of antipsychotic medications for children enrolled in Medicaid and CHIP in Florida and Texas, two of the nation’s largest states.

The team will examine how frequently health-care systems, clinics and providers conduct preventive dental services, including fluoride treatments and sealants, and oral health care during well-child exams. Dental decay is the most common childhood disease and, if left untreated, can result in missed school days, hospitalization and emergency room visits. More than 80 percent of children receive preventive dental visits in Texas and 60 percent receive these visits in Florida, which are covered by their insurance.

The team will also assess whether antipsychotic medications are administered appropriately or are overused among children in the states’ Medicaid and CHIP programs. They will examine the use of antipsychotic medication in children under 5, the use of higher-than-recommended dosages and the use of multiple, concurrent antipsychotics.

In addition, the team will measure whether children who are on antipsychotic medication are properly monitored for the variety of metabolic-related issues that are frequent side effects of these medications, such as weight gain and significant increases in blood glucose, cholesterol and triglyceride levels. Currently, only 31 percent of children in Medicaid in Texas and 35 percent of children in Medicaid in Florida who receive antipsychotic medication have any metabolic screening. Without screening and regular monitoring, these children are at increased risk for developing myriad health complications, such as obesity and diabetes.

In a preliminary wave of funding, the PQMP Centers of Excellence developed a set of new pediatric measures. With a grant of $675,000, the UF Health team will be among researchers at six institutions who will participate in the next phase of work, which will implement and test these newly developed pediatric measures in real-world settings.

While the oral health and antipsychotic medication monitoring measures are considered best practice, clinical adherence to these measures is far from universal. By using large data sets on Texas and Florida’s Medicaid and CHIP programs housed at UF, the UF Health team will run the measures against the data to first ensure the measures work properly, meaning they are feasible and usable with actual clinical data. The Texas and Florida data are housed at UF due to long-standing relationships with the state agencies to evaluate the quality of care that children in Medicaid receive. This will provide the research team with a real-world picture of clinical practice. Then the team will work at the state, health plan and provider levels to support performance monitoring and quality improvement.

The UF Health team is part of a statewide organization called the OneFlorida Clinical Research Consortium, which seeks to improve health, health care and health policy for the state. Through this consortium, the team will collaborate with PEDSnet, a national network of pediatric hospitals and health-care systems, to test the antipsychotic measures within their database as well. Both are members of PCORnet, funded by the Patient-Centered Outcomes Research Institute. This national initiative aims to make clinical research faster, easier and less costly by harnessing the power of big data.

“By running these queries in such large national data networks, we can be confident that our discoveries will have practical and real-world relevance to the health care for vulnerable children,” said Christopher Forrest, M.D., Ph.D., a professor of pediatrics at the Children’s Hospital of Philadelphia and national co-chair of the PCORnet Pediatrics Collaborative Research Group with Shenkman. “By working together across large research networks, we are amplifying the impact of this funding and improving the efficiency of health care research, which aligns perfectly with the goals of PCORnet.”

The data collected for all 13 members of PCORnet must be uniform, allowing researchers to conduct large national studies that have previously been impossible. Learn more about the OneFlorida Clinical Research Consortium here, PEDSnet here or PCORnet here.

The UF Health research team will also collaborate with several dental and health plans in Texas and Florida, including Superior HealthPlan, Texas Children’s Health Plan, DentaQuest and MCNA Dental Plan, as well as the Texas Health and Human Services Commission, the Florida Healthy Kids Corporation and the Agency for Health Care Administration in Florida.

“The Agency for Health Care Administration is committed to improving care for all of our Medicaid and CHIP participants, especially our children,” said Justin Senior, Agency for Health Care Administration interim secretary. “We are pleased to partner with the University of Florida to test how these newly developed quality measures can help us improve the health of the children we serve. I look forward to working with all of the parties involved with this study.”

This new effort is funded through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; Public Law 114-10 Section 304(b)), which provided continued funding for the Pediatric Quality Measure Program to build knowledge and evidence to support performance monitoring and quality improvement for children in Medicaid and CHIP.

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