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HIT Policy Committee/ Quality Measure Workgroup RFC Summary. QUM WG 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

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Qum wg rfc summary

HIT Policy Committee/ Quality Measure Workgroup RFC Summary

QUM WG RFC Summary

February 2, 2011


Findings total respondents

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

Abbott Nutrition Products Division, Abbott

Agency for Healthcare Research and Quality

Alliance for Nursing Informatics

America’s Health Insurance Plans

American Academy of HIV Medicine, Association of Asian Pacific Community Health Organizations, HIV Medicine Association, National Alliance of State & Territorial AIDS Directors, Partnership for Prevention, and Trust for America's Health

American Academy of Hospice and Palliative Medicine

American Academy of Ophthalmology

American Academy of Pediatrics

American College of Physicians

American College of Preventive Medicine

American College of Radiology IT & Informatics Committee/GR Subcommittee

American College of Surgeons

American Dietetic Association

American Foundation for Suicide Prevention

American Hospital Association

American Medical Association

American Nurses Association

American Society of Clinical Oncology

Arizona Health Care Cost Containment System

Association for Professionals in Infection Control and Epidemiology

Association of American Medical Colleges

Baylor Health Care System

Boston University School of Public Health; and Veterans Administration

California Maternal Quality Care Collaborative

California Primary Care Association

Campaign for Better Health

Care Continuum Alliance

Case Western Reserve University

Catholic Health East

Catholic Healthcare

Centers for Disease Control and Prevention, National Center for Injury Control and Prevention

Certification Commission for Health Information Technology

Charlotte Hungerford Hospital

Cheboygan Memorial Hospital

Childbirth Connection

Clinical Inservices Solutions, LLC

Consumer Partnership for eHealth

Consumer-Purchaser Disclosure Project

Dartmouth Institute

Davis Family Physicians

Delaware Health Net

Disability advocacy groups (43 co-signers)

Drs. Concannon & Vitale, LLC

Duke

Durham Regional Hospital

Eastern Maine Healthcare Systems

Epic

GE Healthcare IT

George Washington University

Golden Living, LLC & LTPAC HIT Collaborative

Gundersen Lutheran Health System

Health Dialog

Health Economics Group+A2

Health IT Now Coalition

Health Resources and Services Administration


Organizations1

Organizations

HealthInsight Regional Extension Center

HealthPartners Research Foundation

Healthwise

HealthyCircles, LLC

HMS

Hospice and Palliative Care Coalition

Hospital Executive Council

Indian Health Service

Intuit Health

Kaiser Permanente

Local Public Health Association of Minnesota

Massachusetts General Hospital

McKesson Provider Technologies

MEDai / an Elsevier Company

Memorial University Medical Center

Minnesota Counties Computer Cooperative

Minnesota Department of Health

Missouri Hospital Association

NASMHPD

National Association of Community Health Centers

National Center for Cognitive Informatics & Decision Making

National Coalition for Cancer Survivorship

National Committee for Quality Assurance

National Health IT Collaborative for the Underserved

National Partnership for Women & Families

Nemours

Neumann University

New York Chapter, American College of Physicians

New Yorkers for Accessible Health Coverage

Newborn Coalition

North Carolina Bio-Preparedness Collaborative

Oregon Health & Science University Center for Ethics in Health Care

Partners Healthcare

Patient Privacy Rights

Pediatrix Medical Group

Pharmacy e-HIT Collaborative

Philips

PhRMA

Planned Parenthood Federation of America

Qualidigm

REACH (MN-ND HIT Extension Center)

Riverbend Medical Group

Scots Pine Clinic, PLLC

SHAPE HITECH, LLC

Social & Scientific Systems

Society for Participatory Medicine

Society of Behavioral Medicine

St. Joseph Health System

Stanford University

State of Oregon Health Information Technology Oversight Council

Surescripts

TeenScreen National Center for Mental Health Checkups at Columbia University

Texas Department of State Health Services

UnitedHealth Group

University of Wisconsin School of Medicine and Public Health

VersaForm Systems Corp

Washington University School of Medicine


Criteria for measure selection

Criteria for Measure Selection

  • *National Quality Forum, 2013 eQM Report


Measure domain areas

Measure Domain Areas

  • Patient & Family Engagement

  • Clinical Appropriateness/Efficiency

  • Care Coordination

  • Patient Safety

  • Population & Public Health


Findings measure recommendations

Findings: Measure Recommendations


Additional 113 retooled measures by specialty

Additional 113 Retooled Measures by Specialty


Patient family engagement

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

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

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

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

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

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

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 steps1

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


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