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