Download Most Promising Measures

HIT STANDARDS COMMITTEE CLINICAL QUALITY MEASURE UPDATE
Thomas Tsang, MD, MPH
ONC
February 16, 2011
Background
• Stage 1 Meaningful Use requires 3 core and 3
additional CQMs for EPs and 15 CQMs for
hospitals to be reported (aggregate level data for
numerator, denominator and exclusions through
attestation)
• Stage 1 contains 44 ambulatory care measures
for EPs
• Stage 2 incorporates a transparent and
collaborative process for prioritization for
measure concept/selection process
• HIT PC QWG-six tiger teams created
Clinical Quality Measures
Establish National
Priorities
Identify Measures
Harmonize and
Coordinate
Testing/Validation
of e-Specifications
Identify Measure
Gaps
Measure
Development
Retooling Process
Interagency Input
and Public
Comment
Public Comment
Vocabulary Sets
required for
Certified EHRs
Incorporate into
Final Rule
Confidential For Internal Use Only
Quality Measures Workgroup
David Blumenthal, Chair
David Lansky, Co-Chair
Peter Basch
Christine Bechtel
Trip Bradd
Russ Branzell
Helen Burstin
Neil Calman
Carol Diamond
Timothy Ferris
Patrick Gordon
David Kendrick
Charles Kennedy
Karen Kmetik
Robert Kocher
Norma Lang
J. Marc Overhage
Laura Petersen
Jacob Reider
Sarah Scholla
Cary Sennett
Jesse Singer
Paul Tang
Joachim Rosti
James Walker
Paul Wallace
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National Coordinator for Health IT
Pacific Business Group on Health
Medstar
National Partnership for Women & Families
Skyline Family Practice, VA
Poudre Valley Critical Access Hospital, CO
National Quality Forum
Institute for Family Health
Markle Foundation
Partners Healthcare
Colorado Beacon Consortium
Greater Tulsa Health Access Network, OK
WellPoint, Inc.
American Medical Association
McKinsey & Co.
University of Wisconsin
Regenstrief Institute
Baylor University
AllScripts
NCQA
MedAssurant
NYC Department of Health
Palo Alto Medical Foundation
Brookings Institute
Geisinger
Kaiser Permanente
Partners
HIT POLICY COMMITTEE / QUALITY WORK GROUP:
Federal Ex Officio Members
− AHRQ
-HRSA
− SAMSHA
-ASPE
− ONC
− IHS
− AHRQ
− CMS
Confidential For Internal Use Only
eQM Criteria
STATE OF READINESS
– state of measure development and
pipeline/endorsement status
HIT-SENSITIVE
– evidence that measure can be built into EHRsystems
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
LONGITUDINAL
MEASUREMENT
– enables assessment of a longitudinal, conditionspecific, patient-focused episodes of care.
*National Quality Forum, 2013 eQM Report
Confidential For Internal Use Only
Stage 2 Priority Measure Concepts
PATIENT AND FAMILY ENGAGEMENT
• Self-management/Activation
• Honoring Patient Preferences and Shared Decision Making
• Public Health Outcomes
• Community Resources Coordination/Connection
CLINICAL APPROPRIATENESS
• Appropriate/Efficient Use of Facilities
• Appropriate/Efficient Use of Diagnostic Tests
• Appropriate/Efficient Treatment of Chronic Disease Across Multiple Sites of Care
• Appropriate/Efficient Use of Medications
CARE COORDINATION
• Effective Care Planning
• Care Transitions
• Appropriate and Timely Follow-Up
PATIENT SAFETY
• Medication Safety
• Hospital Associated Events
POPULATION AND PUBLIC HEALTH
• Health Lifestyle Behaviors
• Effective Preventative Services
• Health Equity
Confidential For Internal Use Only
Findings from Request for Comment
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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
Abbott Nutrition Products Division, Abbott
Agency for Healthcare Research and Quality
Alliance for Nursing Informatics
America’s Health Insurance Plans
American Academy of HIV Medicine, Association of Asian Pacific
Community Health Organizations, HIV Medicine Association, National
Alliance of State & Territorial AIDS Directors, Partnership for Prevention,
and Trust for America's Health
American Academy of Hospice and Palliative Medicine
American Academy of Ophthalmology
American Academy of Pediatrics
American College of Physicians
American College of Preventive Medicine
American College of Radiology IT & Informatics Committee/GR
Subcommittee
American College of Surgeons
American Dietetic Association
American Foundation for Suicide Prevention
American Hospital Association
American Medical Association
American Nurses Association
American Society of Clinical Oncology
Arizona Health Care Cost Containment System
Association for Professionals in Infection Control and Epidemiology
Association of American Medical Colleges
Baylor Health Care System
Boston University School of Public Health; and Veterans Administration
California Maternal Quality Care Collaborative
California Primary Care Association
Campaign for Better Health
Care Continuum Alliance
Case Western Reserve University
Catholic Health East
Catholic Healthcare
Centers for Disease Control and Prevention, National Center for Injury
Control and Prevention
Certification Commission for Health Information Technology
Charlotte Hungerford Hospital
Cheboygan Memorial Hospital
Childbirth Connection
Clinical Inservices Solutions, LLC
Consumer Partnership for eHealth
Consumer-Purchaser Disclosure Project
Dartmouth Institute
Davis Family Physicians
Delaware Health Net
Disability advocacy groups (43 co-signers)
Drs. Concannon & Vitale, LLC
Duke
Durham Regional Hospital
Eastern Maine Healthcare Systems
Epic
GE Healthcare IT
George Washington University
Golden Living, LLC & LTPAC HIT Collaborative
Gundersen Lutheran Health System
Health Dialog
Health Economics Group+A2
Health IT Now Coalition
Health Resources and Services Administration
Organizations
HealthInsight Regional Extension Center
HealthPartners Research Foundation
Healthwise
HealthyCircles, LLC
HMS
Hospice and Palliative Care Coalition
Hospital Executive Council
Indian Health Service
Intuit Health
Kaiser Permanente
Local Public Health Association of Minnesota
Massachusetts General Hospital
McKesson Provider Technologies
MEDai / an Elsevier Company
Memorial University Medical Center
Minnesota Counties Computer Cooperative
Minnesota Department of Health
Missouri Hospital Association
NASMHPD
National Association of Community Health Centers
National Center for Cognitive Informatics & Decision Making
National Coalition for Cancer Survivorship
National Committee for Quality Assurance
National Health IT Collaborative for the Underserved
National Partnership for Women & Families
Nemours
Neumann University
New York Chapter, American College of Physicians
New Yorkers for Accessible Health Coverage
Newborn Coalition
North Carolina Bio-Preparedness Collaborative
Oregon Health & Science University Center for Ethics in Health Care
Partners Healthcare
Patient Privacy Rights
Pediatrix Medical Group
Pharmacy e-HIT Collaborative
Philips
PhRMA
Planned Parenthood Federation of America
Qualidigm
REACH (MN-ND HIT Extension Center)
Riverbend Medical Group
Scots Pine Clinic, PLLC
SHAPE HITECH, LLC
Social & Scientific Systems
Society for Participatory Medicine
Society of Behavioral Medicine
St. Joseph Health System
Stanford University
State of Oregon Health Information Technology Oversight Council
Surescripts
TeenScreen National Center for Mental Health Checkups at Columbia
University
Texas Department of State Health Services
UnitedHealth Group
University of Wisconsin School of Medicine and Public Health
VersaForm Systems Corp
Washington University School of Medicine
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 – supports assessment of patient health risks that can be used for
risk adjusting other measures and assessing change in outcomes
AND OUTCOMES
MEASUREMENT
LONGITUDINAL – enables assessment of a longitudinal, condition-specific, patientMEASUREMENT focused episode of care.
*National Quality Forum, 2010 Gretsky Group
Report
Measure Domain Areas
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Patient & Family Engagement
Clinical Appropriateness/Efficiency
Care Coordination
Patient Safety
Population & Public Health
Findings: Measure Recommendations
1100 recommended measures
491 unique measures recommended
draft superset
of Stage 2
and 3
measures
overlap of 79
retooled
measures
113 already
retooled measures
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
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)
*NQF 2010
Preferences
PHR
Social / Cultural
Clinicians
Healthcare
Organization
s
EHR
Behavioral
Environment
Electronic Quality
Measures using the QDS
Individual
Family
Social Context
Resources
Quality Data Set
(QDS) element
Clinical Care
Enabling Quality Through
Measurement and
Interoperability
Communities
registry
Public Health
Universal Interoperable
Health IT Standards using
the QDS
Issues for HIT Standards
• Recommendation and feedback of data
elements for future e-measures (using the QDS
model developed by NQF, funded by HHS)
• Guidance and recommendation needed on
evolution of QDS
• Guidance on vocabulary sets for e-measures
• Recommendations on methodologic issues
related to eQMs (e.g.-patient self reported
measures, delta measures)