Quality Measures Update
HIT STANDARDS COMMITTEE -CLINICAL QUALITY MEASURE
UPDATE
Thomas Tsang, MD, MPHONC 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
Confidential For Internal Use Only
Establish National Priorities
Identify Measure Gaps
Public Comment
Identify Measures
Harmonize and Coordinate
Measure Development
Retooling Process
Vocabulary Sets required for
Certified EHRs
Testing/Validation of e-Specifications
Interagency Input and Public
Comment
Incorporate into Final Rule
Quality Measures Workgroup− 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
David Blumenthal, ChairDavid Lansky, Co-Chair
Peter BaschChristine Bechtel
Trip Bradd
Russ BranzellHelen Burstin
Neil CalmanCarol DiamondTimothy Ferris
Patrick Gordon David Kendrick
Charles KennedyKaren Kmetik
Robert Kocher
Norma LangJ. Marc Overhage
Laura PetersenJacob Reider
Sarah Scholla
Cary SennettJesse Singer
Paul TangJoachim RostiJames WalkerPaul Wallace
Partners
Federal Ex Officio Members−AHRQ -HRSA−SAMSHA -ASPE−ONC−IHS−AHRQ−CMS
HIT POLICY COMMITTEE / QUALITY WORK GROUP:
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 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
LONGITUDINAL MEASUREMENT
– enables assessment of a longitudinal, condition-specific, patient-focused episodes of care.
*National Quality Forum, 2013 eQM Report Confidential For Internal Use Only
Stage 2 Priority Measure Concepts
Confidential For Internal Use Only
Findings from Request for Comment
• 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, 2010 Gretsky Group 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
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)
Enabling Quality Through Measurement and Interoperability
Enabling Quality Through Measurement and Interoperability
Electronic Quality Measures using the QDS
Universal Interoperable Health IT Standards using
the QDS
Quality Data Set (QDS) element
Environm
entR
esourcesC
linical Care
CliniciansHealthcare Organizations
IndividualFamilySocial Context
CommunitiesPublic Health
EHR
PHR
registry
*NQF 2010
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)