Quality Measurement 101: What You Need to Know for Successful Quality Initiatives at your Organization

1. Quality Measurement 101: What You Need to Know for Successful Quality Initiatives at your Organization Louis H. Diamond, MD June 2010

2. 2 Louis Diamond works for Thomson Reuters Healthcare and Science. No products will be discussed during the presentation.

3. 3 Learning Objectives Describe the basic dimensions of quality Discuss the definitions and uses of evidence based medicine Outline the basics of clinical performance measures Outline the ARRA HIT and quality measurement requirements Describe the national quality measurement and improvement enterprise

4. 4 The Triple Threat Need to cover the uninsured Know how to do Deep political divide Bridge the quality gap Complex solutions and multi-dimensional Controlling costs Do not know how to do A central problem

5. 5 Trends in Bridging the Quality and Performance Gap Continued interest in measuring quality AND cost of care/efficiency Focus on P4P and re-imbursement re-alignment Public reporting of performance metrics Shift in focus from measuring performance of health plans and hospitals only to the physician and now to “accountable clinical organizations” (ACOs) NQF adopts multiple measurement sets for physician level performance assessment AND have developed national priorities for action Health information technology and performance improvement “merge” – ARRA-2009 Federal Stimulus legislation. PPACA calls for expanded role for NQF---set national priorities, facilitate additional measure creation and provide input to CMS on measure selection

6. 6 Trends in Bridging the Quality and Performance Gap (cont’d) CMS implementing P4R programs for physician level measures, to be followed by a P4P programs IOM makes recommendation on P4P, the creation of “learning” systems, and EBM adoption and use Building out the HIT infrastructure to support quality measurement and POC DSS (CDS) The recognition of the limitations of evidence Commitment to patient centeredness – the voice of the patient

7. 7 Definition of Quality (IOM) The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

8. 8 Cost/Quality Trade Off Curve

9. 9 The Dimensions of Conducting Quality Improvement Quality measures Clinical decision support – CDS – point of care decision support Engage healthcare professionals Engage and activate patients and families Implementation components - leadership, culture, supportive HIT, tools, e.g. Six Sigma, rapid cycle Drivers-accreditation and certification; financial incentives

10. 10 Performance Improvement: Patients and Populations

11. 11 Evidence Based Medicine: Definition Evidence-based medicine is the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients

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15. 15 Clinical Practice Guidelines (CPGs): Definition Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances

16. Quality: Dimensions and Measurement Structural, process and outcomes Over use, under use and misuse Safety, practice consistent with current professional knowledge and customization Care should be safe, timely, effective, efficient, equitable and patient centered (STEEEP) 16

17. 17 A Model of the Influence of External Drivers on Quality

18. 18 Quality Measures from a Patient’s Perspective Staying healthy Dealing with acute disease Dealing with chronic disease and disability Dealing with end of life

19. 19 Clinical Performance Measure (A Quality Measure) A measure - a rate Assesses if a service has been delivered And an outcome achieved Attributes to the provider being assesses Covers prevention, diagnosis, management, decision making, implementation, technical proficiency and communication Used for internal quality improvement/public reporting, for P4P, for MOC

20. 20 Examples of Domains of Performance with a Focus on the Domain of Quality

21. 21 Use/Quality Measures Spectrum

22. 22 Dimensions of a Good Quality Measure Process and outcome Derived from a CPG or otherwise derived from evidence Precisely defined – numerator, denominator, exclusions Methodological – data source, sampling, time window, scoring, display Fully specified-eMeasure Actionable Tested (e.g. collectable and reliability)

23. 23 A Formula for Success: The CDS Five Rights To improve care outcomes with CDS you must provide: the Right Information… Evidence-based, useful for guiding action and answering questions …to the Right Stakeholder… Both clinicians and patients …in the Right Format… Alerts, Order Sets, answers, etc. …through the Right Channel… Internet, mobile devices, clinical information systems …at the Right Point in the Workflow To influence key decisions/actions

24. 24 CDS Intervention Types Relevant data presentation: flowsheets, surveillance Order creation facilitators: order sentences, sets Reference information: infobuttons, Web Unsolicited alerts: proactive warnings Documentation templates: patient history, visit note Protocol support: pathways

25. 25 Workflow Opportunities

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28. 28 Performance Measurement and Quality Improvement “System”

29. 29 Health Information Technology: National Enterprise

30. 30 National Priorities Improve the Health of the Population Engage Patients and Families in Managing Health and Making Decisions about Care Improve the Safety of America’s Healthcare System Ensure Patients Received Well-Coordinated Care across all Providers, Settings, and Levels of Care Guarantee Appropriate and Compassionate Care for Patient with Life-Limiting Illnesses Eliminate Waste While Ensuring the Delivery of Appropriate Care

31. 31 This presentation discusses a NPRM and not the final rules. The reader is cautioned that the final rules will likely differ from the current drafts published in the Federal Register on January 13, 2010. The NPRM published on 1-13-2010 in the Federal Register contains slight differences from the NPRM released by CMS on 12-30-2009 including pagination and page numbers.

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33. 33 MU Goals Improve quality, safety, efficiency and reduce disparities Engage patients Improve coordination of care Ensure privacy and security of PHI Improve population health and interact with public health programs

34. 34 HITECH MU Requirements Expand in Stages

35. 35 CMS RHQDAPU + JCAHO Core Measures + MU Quality Measures = Complex Medicare Quality Reporting

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37. 37 The Chronic Care Model

38. Contact Louis Diamond VP and Medical Director Healthcare and Science Thomson Reuters D: 301-468-0666  C: 202-285-6729 louis.diamond@thomsonreuters.com