qum wg rfc summary
DESCRIPTION
HIT Policy Committee/ Quality Measure Workgroup RFC Summary. QUM WG RFC Summary. February 2, 2011. Findings: Total Respondents. A total of 134 respondents – 112 organizations and 22 individuals not associated with an organization – responded to the RFC - PowerPoint PPT PresentationTRANSCRIPT
QUM WG RFC Summary
HIT POLICY COMMITTEE/ QUALITY MEASURE
WORKGROUP RFC SUMMARY
February 2, 2011
Findings: Total Respondents
• A total of 134 respondents – 112 organizations and 22 individuals not associated with an organization – responded to the RFC
• 85 organizations and 5 individuals not associated with an organization submitted comments using the online tool
• 27 organizations and 17 individuals not associated with an organization submitted comments via email and/or blog only
Organizations
Organizations
Criteria for Measure Selection
STATE OF READINESS
– state of measure development and pipeline/endorsement status
HIT-SENSITIVE – evidence that measure can be built into EHR-systems
PARSIMONY – applicable across multiple types of providers, care settings and conditions
PREVENTABLE BURDEN
– evidence that measurement can support potential improvements in population health and reduce burden of illness
HEALTH RISK STATUS AND
OUTCOMES MEASUREMENT
– supports assessment of patient health risks that can be used for risk adjusting other measures and assessing change in outcomes
LONGITUDINAL MEASUREMENT
– enables assessment of a longitudinal, condition-specific, patient-focused episode of care.
*National Quality Forum, 2013 eQM Report
Measure Domain Areas
• Patient & Family Engagement• Clinical Appropriateness/Efficiency• Care Coordination• Patient Safety• Population & Public Health
Findings: Measure Recommendations
1100 recommended measures
491 unique measures recommended113 already
retooled measures
overlap of 79 retooled measures
draft superset of Stage 2
and 3 measures
Additional 113 Retooled Measures by Specialty
SPECIALTY # OF MEASURES
Anesthesia 1
Cardiology 9Emergency Medicine 10
Endocrinology 8
Family Medicine 20
Gastroenterology 5
General Practice 25
Geriatrics 3
Gynecology 4
Infectious Diseases 17Intensive Care Medicine 20
Nephrology 2
SPECIALTY # OF MEASURES
Neurology 2
Nuclear Medicine 3
Obstetrics 3
Other 6
Pediatrics 15
Podiatry 2
Psychiatry 7
Pulmonology 4
Radiology 7
Rehabilitation 4
Rheumatology 2
Surgery 14
Patient & Family Engagement
Most Promising Measures• Patient experience of care & HIT connection with
providers• Measurement of functional status & health risk• Patient activation and self-management skills
Methodological Issues• Defining discrete measures from larger validated
instruments• Data platform for patient-reported measures• Sampling versus census approach to data collection
Clinical Appropriateness/Efficiency
Most Promising Measures• Lipid Control using Framingham risk score • Measure assessing the appropriate use of diagnostic
imaging procedures, with measures for redundancy, cumulative exposure, and appropriateness
• Measure assessing appropriate medication treatments, including overuse and/or underuse
Methodological Issues• Readmissions measures currently are using claims and
administrative data (incorporation of claims)• Measures using risk assessment scores and algorithms
will need further work
Care Coordination
Most Promising Measures• Measure assessing adherence to a comprehensive care plan• Measure of patient and family experience of care
coordination across a care transition• Measure of an advance care plan as a product of shared
decision making• Composite measure assessing receipt by both care team
members and the patient/caregiver of a comprehensive clinical summary after a transition
Methodological Issues• Acknowledging the current state of interoperability to
permit adequate care coordination• Verifying that care coordination has occurred• Standardizing longitudinal record or action plan for patients• Defining specific elements of a comprehensive care plan
Patient Safety
Most Promising Measures• Adverse Drug Events (ADEs)• Monitoring of patients on chronic medications • Health care associated infections (HAIs) outcome and bundled
process measures• VTE outcomes• Falls risk assessment
Methodological Issues• Meaningful measurement of ADEs• Capturing relatively rare events (HAIs, VTEs, ADEs)• Measures of falls and ADEs applicable in both hospital and
ambulatory settings• Risk adjustment of measures
Population & Public Health
Most Promising Measures• Measure assessing patients with undiagnosed
hypertension using a calculated algorithm• Longitudinal assessment of blood pressure• Longitudinal assessment of blood glucose• Stratify quality measures by patient demographics
information*
Methodological Issues• Population health management presents challenges to
traditional outcomes measurement• Standard data entry conventions need to be identified
for some measures
* Not a quality measure but a methodology for reporting
Gap Areas
• Measures of decision quality• Comprehensive Clinical Summary• Closing the referral loop measure• Measures related to action plans for patients • Measures to meaningfully capture adverse
drug events• Health equity measures (e.g. population-based
interventions)• Readmission measures and medication
adherence measures require multiple sources of data
Next Steps• A superset of measure
concepts/measures to be recommended
• Individual Tiger Team meetings for final recommendations
• Further workgroup attention to:• Capturing patient-reported measures• Integration of multiple, longitudinal data sources• Framework for quality measures reporting
(core/menu)
Next Steps• Recommendations from HIT PC/Quality
Workgroup will inform ONC on priority measures/concepts for Stage 2 and Stage 3
• Consideration will be given to harmonization process, stage of readiness, and criteria as outlined (parsimony, HIT sensitivity, etc.)
• Development, testing, validation of measures to be completed by Q4/2011 for Stage 2 and Q4/2013 for Stage 3