Quality MeasuresQuality Measures

Kenneth Salyards Substance Abuse Mental Health Services Administration

U.S. Department of Health & Human Services

Regional HIT Conference Washington, DC Thursday, August 11, 2011

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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» 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

Health Reform (HR) Quality Workgroup• 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 • 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 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

Not NQF Endorsed• 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

NQF Endorsed: Not Retooled• Bipolar Disorder and Major Depression: Appraisal for Alcohol or

Chemical Substance Use (NQF 0110) 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.