Implementing Quality Measures for Accountability in Community-Based Care for People with Serious Illness: Proceedings of a Workshop by unknow

Author:unknow
Language: eng
Format: epub
Tags: Health and Medicine: Healthcare and Quality, Health and Medicine: Policy, Reviews and Evaluations
Publisher: The National Academies Press
Published: 2018-10-02T00:00:00+00:00

Identifying gaps, reported Agrawal, is proving to be harder than it sounds, noting, “If you have a clear and glaring measure gap, experts in the room are pretty good at identifying that.” Identifying a gap becomes much more difficult, he added, when there is insufficient evidence to understand what needs to be measured, and will consequently require a much longer-term conversation. These two efforts are occurring in parallel: filling important measurement gaps and prioritizing existing measures.

Agrawal described the methodology behind the prioritization process (see Figure 5). “We are trying to make the process as numerical as we can so that there is not a lot of subjective bias in what rises to the top as the most important measures,” he explained. Each measure is assessed based on whether it is outcome focused, improvable, meaningful to patients and caregivers, and supports a systemic and integrated view of care. Agrawal also noted that in future phases of the work, NQF “will be able to bring a focus on equity as one of the most important elements of prioritization.”

In Agrawal’s view, NQF’s role in measurement cannot end with the endorsement of a measure, which is why he also believes feedback is critical to the organization’s mission. “We need to have a better understanding of what the experience of measure implementation is and if there are any adverse consequences that are being produced,” he said. NQF is rolling out a system and process for getting feedback from as close to the frontlines as possible. One critical element of this system, he emphasized, will be for NQF to act as a consensus builder among stakeholder groups—the government, measure developers, and specialty societies—and produce a more granular understanding of where the burden of measurement lies and ways to generate solutions to measurement challenges.

Referring back to an earlier point, Agrawal wants NQF to help providers build capacity for measurement and quality improvement. He explained that although the general assumption might be that hospitals are inherently good at quality improvement, for example, his experience as an emergency medicine physician and health care consultant is that many institutions lack the core capabilities to engage in continuous improvement activities and understand the true purpose of measures. As an example, he recounted a recent experience when he was working a shift in the emergency department and was caring for a patient with decompensated heart failure who needed to be admitted to the hospital. He called the patient’s cardiologist, and after a heated debate about whether the patient needed to be admitted, the cardiologist revealed that he did not want to face the CMS penalty for readmissions. After Agrawal explained that he worked at CMS and that was not the intention of the readmission penalties, the cardiologist relented, and the patient was admitted.

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