Transcript Anatomy and Physiology of the National Quality Forum
Anatomy & Physiology of the National Quality Forum
J O A N N B R O O K S P H D , R N , F A A N , F C C P S Y S T E M V P , Q U A L I T Y & S A F E T Y I N D I A N A U N I V E R S I T Y H E A L T H
Conflict of Interest Disclosures
Member, Steering Committee, NQF Admissions & Readmissions Others not related to this presentation Cadence Pharmaceuticals—speaker’s bureau Abbott Nutrition—speaker’s bureau
Objectives
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Describe the history, mission & vision of the NQF Identify how the NQF fits into the CMS Triple Aim, the National Quality Strategy & health information technology (EHR, eMeasures, etc) Describe the criteria for the development of a performance measure & the process for endorsement Identify how an individual or NQF member may actively participate in the work of the National Quality Forum & stay informed on present & future performance measures
What ‘clinical quality’ really means in 2014
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Most providers don’t know the level of quality they provide, but assume it’s excellent External-agency quality awards are imperfect and sometimes misleading indicators of quality Even government-sanctioned core measures are highly imperfect indicators of quality
Care Transformation Center Blog, Jim Field; March 5, 2014
1998
President's Advisory Commission on Consumer Protection & Quality in the Health Care Industry State of Health Care Quality Avoidable errors Underuse of health care services Overuse of services Variation in services National commitment needed to the measurement, improvement & maintenance of high-quality health care
Historical Aspects NQF
1999 Incorporated 501(c)-3 2002 First set of endorsed standards SREs 2007 Endorsed measures 250 2009 HHS contract
1999
NQF created by coalition of public & private-sector leaders in response to commission report Private, non-profit, voluntary consensus standards setting organization Today received funding from public & private sources In 2009 received DHHS contract
NQF & HHS Contract
Four year contract 2009-2013 ~$40 million Work on five domains: Recommendations on national strategy & priorities Endorse quality measures Maintain quality measures--update or retire Promote EHR Report annually to Congress
Mission
• Building consensus on national priorities & goals for performance improvement and working in partnership to achieve them • Endorsing national consensus standards for measuring & publicly reporting on performance • Promoting the attainment of national goals through education & outreach programs.
Vision
To be the convener of key public & private sector leaders to establish national priorities & goals to achieve healthcare that is safe, effective, patient-centered, timely, efficient & equitable NQF-endorsed standards will be the primary standards used to measure & report on the quality & efficiency of healthcare in the United States To be a major driving force for & facilitator of continuous quality improvement of American healthcare quality
Organization comprised of many different voices, ideas, and thoughts coming together. The cause of making healthcare both safe and affordable, and people healthy, cuts across a wide variety of different stakeholders
Governance & Leadership
CEO Dr. Christine Cassel, MD Board of Directors Board Committees Consensus Standards Approval Committee Health IT Advisory Committee Leadership Network National Priorities Partnership Measure Applications Partnership Member Councils
Unique Features
Open membership Public & private sector representation Attention to overall strategy for measuring & reporting healthcare quality Focus is the entire continuum of healthcare Has a formal consensus process
NQF Membership
Consumer Organizations Health Plans Health Professional Organizations Public & Community Health Organizations Hospitals, Health Systems Industry
NQF 2013 Report to Congress
Continued recommendations for the National Quality Strategy & Priorities Quality & efficiency measurement initiatives (performance measures) Stakeholder recommendations on quality & efficiency measures (MAP) Gaps in endorsed quality & efficiency measures; evidence & targeted research needs Consensus Development Process
National Quality Strategy & Priorities
2010
Request of HHS, convened the National Priorities Partnership (PPS) that helped shape the initial version of the National Quality Strategy National Priorities Partnership (co-chairs Don Berwick MD & Margaret O’Kane) Provided roadmap for: Achieving better, more affordable care and better health
National Priorities Partnership
The NPP is a partnership of 52 major national organizations with a shared vision to achieve better health, & a safe, equitable & value-driven healthcare system.
Copyright ©2014 NQF
Priorities
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Making care safer by reducing harm caused in the delivery of care Ensuring that each person & family is engaged as partners in their care Promoting effective communication & coordination of care Promoting the most effective prevention & treatment practices for the leading causes of mortality, starting with cardiovascular disease Working with communities to promote wide use of best practices to enable healthy living.
Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models
Supporting Partnership for Patients
Developed action teams Reducing preventable inpatient harm Reducing readmissions for complex & vulnerable populations Engaging patients & families in health systems improvement
Patient Focused Episode of Care Model
Copyright ©2014 NQF
Patient Focused Episode of Care Model
Copyright ©2014 NQF
Quality & Efficiency Measurement Initiatives
Quality & Efficiency Measurement Initiatives
Since 1999 developed over 700 NQF-endorsed measures across continuum Current state Focus on “maintenance” process Review previous & newly endorsed measures Relevancy – review all measures in an area Harmonization 2013 added 27 new measures; removed 95
NQF Measure Portfolio
Measure Steward
CMS NCQA PCPI AHRQ Resolution Health The Joint Commission ActiveHealth Mgmt
# of Measures
117 104 94 56 23 22 22
Percent
17% 15% 14% 8% 3% 3% 3%
Copyright ©2014 NQF
Copyright ©2014 NQF
Copyright ©2014 NQF
Other Work
Advancing Measurement Science Evaluating composite measures eMeasure feasibility Measurement Endorsement Pulmonary & critical care Neurology Infectious disease Patient safety
eMeasure Feasibility
More clarity needed about testing NQF identified 7 feasibility recommendations Report provides guidance to help guide future of eMeasure development, testing & certification
Future Endorsement Work
Admissions & readmissions Endocrine CV Care coordination Person-family centered care Episode groupers from administrative claim data Risk adjustment for performance measures Work with AHRQ to develop common formats of SREs
Measure Applications Partnership
Measure Application Partnership
Launched April 7, 2011 Public-private partnership Serve as the neutral convener of multi-stakeholder groups that will provide input on selecting measures for use in federal public reporting & performance-based payment programs Provides feedback for >20 federal public reporting & performance based pay programs PRIOR to rule making
Building Blocks to Efficiency & Value
Copyright ©2014 NQF
MAP
Copyright ©2014 NQF
MAP
Copyright ©2014 NQF
Distribution by NQS Priority of Measures in HHS Programs 2/2013
Copyright ©2014 NQF
Gaps
Gaps
Adult immunization Alzheimer’s disease & related dementias Care coordination Health workforce Person-centered care & outcomes
Other Measure Gaps
Goal-directed, person-centered care planning Shared decision making Systems to coordinate care outside the hospital Beneficiary sense of control/self-determination Psychosocial needs Community integration Optimal functioning
Consensus Development Process
Consensus Development Process
Copyright ©2014 NQF
Evaluation Criteria
Impact, opportunity & evidence—importance to measure Performance gap Reliability, validity Usability Feasibility Also Measure based on data from electronic source Clinical data from EHRs Measures which are freely available
Reduce Avoidable Readmissions
Copyright ©2014 NQF
Present Ongoing NQF Projects (4/2014)
Admissions/Readmissions Steering Group Audit of 2010 Safe Practices for Better Healthcare Surgery Measure Evaluation Adult Immunization Group Patient & Family Engagement Action Team Web Mtg Care Coordination Measures Behavioral Health Measures
Resources
Field Guide to NQF Resources Phrase book for NQF jargon The ABCs of Measurement
Working with NQF
Membership, nonmember access Stay engaged & current on measures under review Submit comments during public comment period Utilize resources
Future of Quality Measurement
Potential Roadmap for the Transition Feasible quality measurement implementation that minimizes burden Common platform that serves multiple stakeholders Align measures around patient-centered outcomes across the continuum Conway, PH; Mostashari, F, Clancy, C. (2013). The future of quality measurement for improvement and accountability. JAMA 309(21); 2215-2216
Future of Quality Measurement
Strategic Shifts Complexity of clinical data may need to be minimized; how can data elements be captured as part of routine clinical workflow Automated systems need to be established to collect patient reported outcomes & experience of care Increased interoperability & data liquidity Increased reliability of quality measure calculation across health IT systems
Goal of measurement is improvement!
Conway, PH; Mostashari, F, Clancy, C. (2013). The future of quality measurement for improvement and accountability. JAMA 309(21); 2215-2216
From:
The Future of Quality Measurement for Improvement and Accountability
JAMA. 2013;309(21):2215-2216. doi:10.1001/jama.2013.4929
Date of download: 4/14/2014 Copyright © 2014 American Medical Association. All rights reserved.
Malcolm T. MacEachern, MD
“Never the less, our hospitals are now involved in the worst financial crisis they have ever experienced. It is absolutely necessary that all of us put our heads together and try to find some solution…. Everything possible has been done to reduce expenditures, but this has not been sufficient to bring about the immediate relief in the majority of instances…”
Source
The Bulletin of the American Hospital Association Vol VI, No 7; July
1932