Download SAMHSA Health Information Technology Initiative

Quality Measures
Kenneth Salyards
Substance Abuse Mental Health Services Administration
U.S. Department of Health & Human Services
Regional HIT Conference
San Francisco, CA  Thursday, July 21, 2011
Measure Collaborators
 SAMHSA
is pleased to be working in collaboration with
the following agencies and organizations:
• Office of National Drug Control Policy (ONDCP)
• Office of the National Coordinator for Health Information
Technology (ONC )
• National Institute on Drug Abuse (NIDA)
• National Institutes of Health (NIH)
• Health Resources and Services Administration (HRSA)
• Agency for Healthcare Research and Quality (AHRQ)
• Centers for Medicare and Medicaid Services (CMS)
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The Need to Measure
 We can be utterly convinced on anecdotal evidence that the
clinical process will yield profound improvements in cost and
quality of care, but unless the effectiveness of clinical
measures are proven with hard data, even sensible
legislation will not be compelling
 This presentation illustrates how standardized information
can be used in a continuous quality improvement (CQI)
process to increase the effectiveness of health care.
One cannot improve what one doesn’t
measure
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What is needed?
The complete multi-provider patient record is essential for the
direct care of patients including the screenings, brief interventions
and treatments.
 The continuous quality improvement (CQI) loop facilitates the
analysis that can actually prove the effectiveness of health care.
Information completeness and comparability is preserved as data
are consolidated for analysis and improvement of the clinical
process.
 Meaningful use (MU) incentives help substantially by encouraging
the collection of comparable screening results, but they do not
promote completeness and comparability of detailed screening
procedures, interventions, and costs.
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Federal-Wide Quality Measure Workgroups
 Quality Measure Development is underway in several
workgroups:
• FACA Quality Measures Workgroup
– Quality Measures Workgroup’s Tiger Teams
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Patient & Family Engagement
Population & Public Health (Where BH is addressed)
Patient Safety
Care Coordination
Efficiency
• Behavioral Health Coordinating Committee
– Co-chaired by Pamela Hyde and Dr. Howard Koh
• DHHS Interagency Workgroup
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Federal Wide Quality Measure Workgroups
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Health Reform (HR) Quality Workgroup
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Co-Chairs: Peter Lee/OHR/HHS, AHRQ & CMS
SAMHSA Leads: Peter Delaney and Kevin Hennessy
Develop a National Quality Strategy Report
Members: All HHS Components and ONC
HIT Policy Committee Quality Measures Workgroup
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ONC Chair: Farzad Mostashari; ONC Lead: Tom Tsang
SAMHSA Lead: Westley Clark
Recommendations for MU Stage 2 Measures
Federal and Private Sector Members
MU 2 rule is being formulated by CMS
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Health Reform Quality Workgroup
 Develop and monitor National Quality Strategy
 Identified Draft National Quality Goals and
workgroups to address each goal:
• Better Care: HACs, Preventable Hospital Readmissions,
Person – Centered Care
• Affordable Care
• Healthy People/Healthy Communities: Community Health
Index improvements
 Aligns with the National Quality Strategy, the HIT MU
2 Measures and the National Prevention Strategy
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BH Measure Recommendations from the Quality
Workgroups
 Better Care
• Reduce the readmission rates in state hospitals
 Healthy People/Communities
• Advocate for community improvements in smoking
cessation and reducing rates for unhealthy alcohol
and drug use
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HIT Quality Measure Subgroup
 Addresses
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HIT Policy Committee Priorities:
Improve quality, safety, efficiency, reduce health
disparities
Engage patients and families
Care coordination across settings and levels of care
Improve population and public health
Ensure privacy and security practices
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HIT Quality Measure Workgroup Outputs
 Measure concepts for Stage 2 MU
• Guidance on statement of work (SOW) for new
measure development
• Includes call for new BH measures
 Guidance on methodological issues such as:
• Developing measure evidence
• Measuring treatment and prevention efficacy
• Including BH structural and performance measures
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HIT Quality Measure Workgroup
 Reviewed Gretzky Report Measure Concept Priority
Areas and Potential Measures for MU Stage 2
• Five Tiger Teams
– Patient and Family Engagement
– Population and Public Health
– Patient Safety
– Care Coordination
– Efficiency
 Recommendations
to ONC, Electronic Quality
Measures (eQM) Taskforce and HR Quality Workgroup
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Population and Public Health
Tiger Team Tasks
 Reviewed crosswalk of Gretzky Report and ONC
measure domains, including readiness criteria:
• NQF endorsed, currently in use, and HIT sensitive, etc.
 Identify Priority Measure Sub-domain
• Preventive services, healthy lifestyle behaviors, equity
 Recommend 3 Measures for each Sub-domain
• Criterion: measures that have significant impact on reducing
mortality
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Population/Public Health Measure
Recommendations
 Effective Preventive Services
• MU 1: blood pressure, glucose screening
• MU 2: blood pressure, glucose control, depression
screening
 Healthy Lifestyle Behaviors
• MU 1: smoking status/intervention, obesity status
(BMI index) and intervention
• MU 2: smoking quit rate; obesity control; alcohol
screening and brief intervention
 Health Equity/Disparities
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SAMHSA BH Measures for Meaningful Use 1
The measures below were HEDIS measures that were retooled
by NQF for meaningful use stage 1. They were included the
CMS meaningful use 1 regulation.
SA Initiation and Engagement (NQF 0004)
 Smoking and Tobacco Use Assessment, Intervention and
Medication Use (NQF 0028)
 New Episode of Depression Treatment during Acute Phase
and Continuation Phase (NQF 0105)
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SAMHSA BH Measures for Meaningful Use 2
 NQF Endorsed and Retooled
• Major Depressive Disorder: Diagnostic Evaluation
(NQF 0103)
• Major Depressive Disorder: Suicide Risk
Assessment (NQF 0104)
• Depression Treatment Management with PHQ 9
(NQF # to be assigned)
• Bipolar Disorder: Level of Function Evaluation
(NQF 0112)
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SAMHSA BH New Measure Recommendations
for Meaningful Use
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Not NQF Endorsed
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Alcohol Screening and Brief Intervention (ASBI; adults)
Depression Screening (PHQ-2 and PHQ-9) for Primary Care
Trauma Exposure Single Question Screener
Follow-up Care for Children Prescribed Attention Deficit Hyperactivity
Disorder (ADHD) Medication
Under NQF Review
• Child and Adolescent Major Depressive Disorder: Suicide Risk
Assessment
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NQF Endorsed: Not Retooled
• Bipolar Disorder and Major Depression: Appraisal for Alcohol or
Chemical Substance Use (NQF 0110)
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NQF Endorsed with e-specification
• Assessment of depression remission at 6 and 12 months – PHQ-2 and
PHQ-9
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SAMHSA Open Behavioral Health Information
Technology Architecture Project
 Next Generation
Open Source EHR can be used for
meaningful use quality measure pilots
• Fully Meaningful Use Criteria Compliant
• Specific Behavioral Health Content
• Reference Electronic Behavioral Health Model (REM)
– Standards derived model EHR application
» HL7 Reference Information Model
» HL7 Clinical Document Architecture
» Uses Apelon Distributed Terminology Server (DTS)
o SNOMED-CT, LOINC, ICD, etc.
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