Health Care Utilization

Pediatric health care utilization measures serve as important indicators of the quality of health systems. The health services research team at VCHIP leverages population-level datasets to assess pediatric health care utilization measures, evaluate health care reform efforts, and inform future initiatives to support family and child health for Medicaid-eligible families in Vermont. A primary data source is Vermont’s all-payer claims database, governed by the Green Mountain Care Board; Vermont Health Care Uniform Reporting and Evaluation System (VHCURES). Past and current measurement priorities include adolescent well-care visits, developmental screening, health care workforce changes, mental health screening and diagnoses, and health supervision during the perinatal period. VCHIP’s health services research team works closely with partners in the Family and Child Health division at the Vermont Department of Health, as the administrators of Vermont’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, to address current health care utilization measurement priorities. 

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Goals &
Achievements
Goals:
  • Measure health care utilization for the Medicaid-eligible children and pregnant people in Vermont.
  • Assess population-level national performance measures and evaluate systems of care, to inform Vermont Medicaid quality improvement efforts.
  • Use data to assess the short- and long-term impacts of VCHIP-led quality improvement initiatives in partnership with other VCHIP projects.
Achievements:
  • Led and supported efforts to bring large secondary health care datasets to UVM for use in research and quality improvement (including Vermont’s All-Payer Claims database (VHCURES) and Vermont Department of Health datasets).
  • Leveraged VHCURES and Vermont administrative data sources to attribute patients to primary care practices annually based on health care use.
  • Quantified health care utilization  using validated quality measures and published algorithms with Vermont’s all-payer claims data:
    • Well-care visits for children and adolescents (Healthcare Effectiveness Data and Information Set (HEDIS) measures Child and Adolescent Well-Care Visits (WCV) and Well-Child Visits in the First 30 Months of Life (W30).
    • Developmental Screening in the First Three Years of Life (DEV-CH), CMS Children’s Core Set.
  • Applied algorithms and classification systems to identify:
    • Mental health and substance use prevalence using the Clinical Classification Software Refines (Healthcare Cost and Utilization Project  ).
    • Patient rurality using Rural-Urban Commuting Area codes (U.S. Department of Agriculture Economic Research Service)   and Rural Areas (Health Resources & Services Administration Federal Office of Rural Health Policy)  .
    • Pediatric patients with chronic and/or complex medical conditions using the Pediatric Medical Complexity Algorithm.
    • The quality of resources and conditions where pediatric patients live using the Child Opportunity Index  .
    • Patient pregnancy using methods developed by Saryani and colleagues   to identify periods before, during and after pregnancy.

  • Analyzed statewide trends in quality measures over time. This work has allowed us to identify areas for targeted quality improvement and support ongoing improvement initiatives throughout Vermont.

  • Supported other VCHIP quality improvement projects (CHAMP, YHII, Transitions, CCCI, STAMPP, Early Childhood).
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Highlights


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Resources
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Project Team

Valerie Harder, PhD, MHS, Professor, Departments of Pediatrics and Psychiatry

Susan Richardson, PhD, Research Analyst

Kassandra Cousineau, MA, Research Data Specialist

Allison Perusse, Research Project Assistant

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