Quality Measurement. HL7 Crossing the Chasm. April 20, 2009
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1 Quality Measurement HL7 Crossing the Chasm April 20, 2009 Floyd Eisenberg, MD, MPH, FACP Senior Vice President, Health Information Technology National Quality Forum
2 Content» NQF» Mission improve the quality of American healthcare by setting national priorities and goals for performance improvement endorse national consensus standards for measuring and publicly reporting on performance promote the attainment of national goals through education and outreach programs 2
3 Content» Participants AHRQ Foundations NQF National Priority Partners QIOs Regional Collaboratives Providers Oversight Organizations Employers Health Plans Fed/State Govt Health Plans Employers Consumers Providers Regional Collaboratives Fed/State Govt. Health Plans Others improve quality incentive policies DRAFT - Quality Alliance Steering Committee evaluate health care public reports national priorities NQF 1. High Quality 2. Equitable Consumer 3. Affordable Outcomes 4. Patient-Centered create measures endorse measures implementation strategies implement, test and aggregate results QASC Regional Collaboratives RHIOs/HIEs CMS States Health Data Stewards NCQA The Joint Commission AMA PCPI Medical Societies Medical Specialty Boards CMS AHRQ Others** NQF QASC Quality Alliances Joint Commission NCQA Medical Specialty Boards 3
4 Content» NQF» Membership A private, non-profit voluntary consensus standards-setting organization Broad membership (350+ members) organized into 8 Councils that Provide stakeholder perspectives to all NQF deliberations; Enable various groups within a council to convene, identify issues and relay information in a unified voice; and Promote collaboration among different groups within a stakeholder perspective. Councils: Consumers Health Care Professionals Health Plans Provider Organizations Public/Community Health Agencies Purchasers Research and Quality Improvement Organizations Supplier & Industry 4
5 Content» NQF» Selected Projects National Voluntary Consensus Standards for Nursing Home Care Hospital Care Healthcare-associated Infections ESRD Care Ambulatory Care Health IT Structural Measures 5
6 Content» NQF» National Priority Partners national priorities establish national priorities and goals for performance measurement and public reporting focus measurement and improvement efforts on achievement of these goals multi-stakeholder Committee with representation from 27 leadership organizations 6
7 Content» NQF» National Priority Partners 27 multi-stakeholder organizations Consumers Purchasers Quality alliances Health professionals/providers Public sector: CMS, NGA, CDC, AHRQ, NIH Accreditation/certification groups Health plans Co-Chairs: Donald Berwick Institute for Healthcare Improvement Margaret O'Kane National Committee for Quality Assurance 7
8 Content» NQF National Priority Partners Provide Effective Care Eliminate Harm Remove Waste Eradicate Disparities 8
9 Content» NQF» National Priority Partners High Impact Areas Patient and family engagement Population health Safety Palliative care Care coordination Overuse Management of patient-focused episodes 9
10 Content» NQF» NPP Framework 10
11 Content» NQF» Strategic Goals high system performance composite measurement outcomes disparities 11
12 Quality and Information Technology F7 12
13 Structure» Quality Measure A well-defined quality measure is composed of a set of common data elements, encoded using standard taxonomies, structured logically into a standardized expression that can be shared and applied to patient data and reported 13
14 Structure» Active Project 26 Measures CMS HITSP Project Spring 2009 Standardize specifications for three (3) inpatient measure sets: 1. Venous Thromboembolism (VTE - 8) 2. Stroke (STK 6) 3. Emergency Department (ED 2) 4. Physician Quality Reporting Initiative (PQRI) Ambulatory Measures (PQRI 10) 5. Demonstration 6. Certification 14
15 Inpatient Measures Venous Thromboembolism (VTE)-1 This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission. 15
16 Inpatient Measures Liquaemin Hepalean VTE Prophylaxis - Medication Warfarin Sodium Coumadin Jantoven Warfarin Arixtra Fonda-parinuxsodium Calciparine Calcilean HEP Hepalean Heparin Heparin Calcium Heparin Leo Heparin Na Heparin Sod Heparin Sodium Heparin Sodium Inj. Heparin Sodium Inj. Pork Heparin Subcu/ SQ/SC/SubQ Coumadin/Warfarin Coumadin/Warfarin Coumadin/Warfarin Coumadin/Warfarin FactorXa FactorXa Ardeparin Dalteparin Danaparoid Enoxaparin Fragmin Innohep Lovenox Normiflo Orgaran Tinzaparin Argatroban (Acova) Bivalirudin (Angiomax) Lepirudin (recombinant hirudin) (Refludan Arixtra Fondaparinuxsodium Calciparine Calcilean HEP LMWH LMWH LMWH LMWH LMWH LMWH LMWH LMWH LMWH LMWH Heparin Heparin Calcium Heparin Leo Heparin Na Heparin Sod Heparin Sodium Heparin Sodium Inj. Heparin Sodium Inj. Pork Heparin Subcu/ SQ/SC Liquaemin Hepalean Heparin Heparin Calcium Heparin Leo Heparin Na Heparin Sod Heparin Sodium Heparin Sodium Inj. Heparin Sodium Inj. Pork Heparin Subcu/ SQ/SC Liquaemin 16
17 Inpatient Measures VTE Prophylaxis Non-medication Anti-Embolism stockings GCS Anti-thrombosis stockings GCS Elastic support hose GCS Graduated compression elastic stockings GCS PAS (Pulsatile anti- embolic stockings) Plexipulse-calf/thigh Pneumatic intermittent impulse compression device Rapid inflation asymmetrical compression (RIAC) devices Jobst stockings GCS Sequential compression device Surgical hose GCS Sequential pneumatic hose TED hose (TEDs) GCS Thromboguard White hose GCS Thrombus pumps- calf/thigh Thrombosis stockings GCS Vascutherm AE pumps (anti-embolic pumps)- calf/thigh VasoPress DVT System Alternating Leg Pressure (ALP) Venodyne boots - calf/thigh Athrombic pumps- calf/thigh AE pumps-foot only Foot Pump DVT boots- calf/thigh A-V impulse system Foot Pump EPC cuffs/ stockings- External pneumatic compression- calf/thigh Flotron/ Flotron DVT system- thigh high Impulse pump -thigh Intermittent pneumatic compression stockings Intermittent compression device (ICD) KCI stockings Leg pumpers Foot pump Kendall AV impulse (foot) Kendall boots Plantar venous plexus pump - foot only Plexiboots- foot only Pneumoboots foot only SC boots- foot only SCD boots- foot only Venous foot pump Foot Pump Foot Pump Foot Pump Foot Pump Foot Pump Foot Pump Foot Pump Foot Pump Foot Pump 17
18 Inpatient Measures Exclusions: Clinical Trial Comfort Measure Only Medical Reason Patient Refusal 18
19 Inpatient Measures Other Measures Selected Elements Warfarin prescribed at discharge Time last known well Monitor using algorithm Overlap therapy Heparin & Warfarin Pre-arrival treatment with lipid lowering agent Surgery end time Assessed for Rehab Services VTE confirmed 19
20 Inpatient Measures Total 89 Data Elements # % of elements EHR Issue Measure Modification Policy Issue Direct Match Unclear % 22% 28% 19% 2% 20
21 Structure» Quality Data Set Build Quality Data Set (QDS) from Existing Measures 21
22 Structure» Quality Data Set Build Quality Data Set (QDS) from Existing Measures Medication List Data Elements 22
23 Structure» Quality Data Set Build Quality Data Set (QDS) from Existing Measures Medication Apply Data Elements to Individual Measures (Reuse individual elements) 23
24 Structure» Quality Data Set Build Quality Data Set (QDS) from Existing Measures AND Data Flow Recorder 24
25 Structure» Quality Data Set Build Measures From Individual QDS Elements: Adding Logic ACE I PrescriptionORARB Prescription - ACE I Allergy + ARB Allergy - Med Reason - Etc Coronary Artery Disease AND Diabetes AND / OR Moderately or Severely Depressed Left Ventricular Systolic Function 25
26 Connecting the Dots Clinical Guidelines Quality Measures Decision Support 26
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