New Harmonization Horizons: Role of NQF

1. New Harmonization Horizons: Role of NQF Helen Burstin, MD, MPH Senior Vice President, Performance Measures TMIT National Test Bed Workshop March 26, 2008

2. NQF Role in the Quality Landscape • Set voluntary, consensus standards • Allow for fair and accurate comparisons across organizations for public reporting • Enable internal quality improvement efforts • Set national priorities and standards • Allow limited health care resources to be focused on high leverage areas • Inform and inspire healthcare leaders • Pull those with diverse perspectives into conversation and action • Quality problems affect all patients and cross the delivery system – NQF is multi-stakeholder

3. NQF Consensus Development Process • Call for nominations and measures (30 days) • Measure evaluation by staff and committees • Public Comment (30 days) • Member Voting (30 days) • Consensus Standards Approval Committee (CSAC) and Board of Directors approval • Appeals (30 days)

4. Criteria for Inclusion: Safe Practices • Specificity. The practice must be a clearly and precisely defined process. • Benefit. If the practice were more widely utilized, it would save lives endangered by health care delivery... or reduce the likelihood of a serious reportable event. • Evidence of effectiveness. There must be clear evidence that the practice would be effective in reducing patient safety events. • research studies • experiential data • research findings or experiential data from non-healthcare industries that should be substantially transferable • Generalizability • Readiness

5. Strengthening the CDP Process: Next Steps • Reassess the NQF Criteria for Endorsement - ongoing CSAC working group • Submission of Composites – Composite Evaluation Steering Committee • Standards must address important areas where improvement will significantly impact health • Process measures will be considered only if associated with improved intermediate/ long-term patient outcomes • Stronger emphasis on harmonization of standards across sites and providers

6. Growth in the Number of Endorsed Measures

7. Strategic Directions • We should measure what is important to achieving the best outcomes for patients and populations • Promote shared accountability and measurement across episodes of care: • Outcome measures • Composite measures • Appropriateness measures • Cost/resource use measures coupled with quality measures.

8. Need for Harmonized Set of Safe Practices IOM “To Err is Human” – 44,000 to 98,000 Americans die each year from preventable medical errors Little progress to date - measures of patient safety showed an average annual improvement of just 1 percent (NHQR 2007) Unclear impact of Patient Safety and Quality Improvement Act and emerging Patient Safety Organizations (PSOs) Growing movement toward public reporting and non-payment for “never events” 8

9. Beginning in FY 2009, cases with these conditions would not be paid at a higher rate unless they were present on admission. Medicare will no longer pay for the additional costs of certain preventable conditions (including certain infections) acquired in the hospital. The rule identifies eight conditions, including three serious preventable events (sometimes called “never events”) that meet the statutory criteria. CMS propose three additional conditions to the list next year (proposed for inclusion: ventilator associated pneumonia, Staphylococcus aureus septicemia, deep vein thrombosis, and pulmonary embolism). CMS Policy on Never Events

10. CMS Never Events Bloodstream infections from using catheters Objects left in a patient during surgery* Urinary tract infections from catheters Air embolism, an air bubble in a blood vessel* An infection after heart surgery called mediastinitis Blood incompatibility, giving a dangerously wrong blood type* Bed sores, or pressure ulcers √ Hospital-acquired injuries, including falls √ *Serious Reportable Event √ AHRQ PSI 10

11. Need for a Safe Practices Crosswalk • NQF Serious Reportable Events (SREs) • Strong interest in conversion to measures • AHRQ Patient Safety Indicators (PSIs) • Currently in NQF pipeline • Healthcare Associated Infections (HAIs) • Measures endorsed in November 2007

12. Not everything that counts can be counted, and not everything that can be counted counts. Albert Einstein

13. National Priorities Partners • NQF is working in partnership with other leadership organizations to establish national priorities and goals for performance measurement and public reporting • Multi-stakeholder committee with representation from 27 organizations(including AMA, AHA, and quality alliances) • Co-chairs • Peggy O’Kane, NCQA • Don Berwick, IHI

14. Preliminary Priority Areas • HAIs: System level measure of infection* • Avoidable Harms: Focus on hospital-level mortality rates and serious adverse events* • Continuity of Care: focus on care coordination and medication reconciliation* • Population health: Global indices of prevention • Overuse: Identify overuse across all specialties • Patient/family engagement: focus on shared decision-making and patient activation • End of life/palliative care: focus on symptom relief

15. Fulfilling Needs for the NPP Standards ready now Urgent to develop Specific Site of Care Across the Continuum

16. Measurement Strategy:HAI • Short-term needs: • HAI measure composite • Longer-term needs: • Harmonize data sets, specifications and collection by CDC, States and others • Validate measures for the ambulatory setting (e.g., ambulatory surgery centers) • Assess going beyond the facility level as the unit of analysis

17. Measurement Strategy: Serious Adverse Events • Shorter term needs - new measure development: • Individual measures of NQF serious reportable events (SREs) and an overall SRE composite at the hospital level. • Longer term needs: • Harmonization of measures for serious adverse events (“never events”) across payers • Global measure that would capture all serious adverse events in hospitals, including SREs and “never events.”

18. Measurement Strategy: Continuity of Care Short term needs: Need for measures that focus on potentially preventable admissions, readmissions, and ED visits Harmonized set of standards for medication reconciliation across sites of care Longer term needs: NQF is launching a new project to identify a set of practices and measures to assess and improve performance along each of the dimensions in the NQF Care Coordination Framework: Healthcare “Home” Proactive Plan of Care & Follow-up Communication Information systems Transitions or Hand-offs 18

19. Additional information Please contact: Helen Burstin, MD, MPH hburstin@qualityforum.org