NQF
THE NATIONAL QUALITY FORUM
Achieving National Quality
Measurement and Reporting
Helen Burstin, MD, MPH
Senior Vice President, Performance Measures
National Quality Forum
Policy Roundtable
Academy Health 2007
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NQF Mission
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To improve the quality of American healthcare by
setting national priorities and goals for
performance improvement,
endorsing national consensus standards for
measuring and publicly reporting on performance,
and
promoting the attainment of national goals through
education and outreach programs.
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What is the NQF?
The National Quality Forum is a
private, non-profit
voluntary consensus standardssetting organization.
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National Technology and Transfer
Advancement of Act of 1995
(NTTAA)
 Defines the five key attributes of a “voluntary
consensus standards-setting body” (i.e., openness,
balance of interest, due process, consensus, and an
appeals process)
 Obligates federal government to adopt voluntary
consensus standards (when the government is
adopting standards)
 Encourages federal government to participate in
setting voluntary consensus standards
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Quality Measurement &
Reporting: Problems
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No national goal setting process
Not enough measures; too many measures
Too much process, not enough outcomes
Numerous methodologic issues
Competency vs high performance measures
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Where are we
with quality measures?
Measure Development
NCQA
PCPI
National Committee
On Quality Assurance
Physician’s Consortium For
Performance Improvement
CMS,
Other Efforts
National Quality
Forum
Measure Endorsement
AQA
Measure Approval for Implementation
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Health Care
Leadership Activated
 Quality Alliances: HQA, AQA, APQ, PQA…
 AMA Physician Consortium for Performance
Improvement
 30+ Specialty Societies
 ANA National Database of Nursing Quality
Indicators (NDNQI)
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NQF
Quality Dashboard
THE NATIONAL QUALITY FORUM
Cost of Care Measures
Quality measures
Efficiency Measures
Patient Experience
With Care
payroll
Accounts
payable
RVU’s
scheduling
M.O.C
Private
Sector
Measures
CMS
PVRP
credentialing
Accounts
receivable
Courtesy of Kevin Weiss, MD
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National Quality
Measurement & Reporting
Infrastructure
 Critically need to:
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Set priorities and goals
Develop and maintain measures
Endorse “Best in Class” measures
Data aggregation
Public reporting
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Quality Measurement
& Reporting: Issues
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Linked process and outcome measures
Episodes of Care (e.g., efficiency, cost, and value)
Measurement gaps (e.g., patient engagement, care
coordination, and self-management)
Methodologic issues (e.g., attribution, exclusions)
Mode of measurement (transition to EHRs?)
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Quality Measurement &
Reporting: Health IT
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Need greater dialogue between the quality and
the health IT communities.
Need to specify the EHR data elements needed
to produce quality measures (focus on quality of
data elements and workflow).
Need to consider how interoperable systems
begin to get us towards high impact gap areas
(e.g., transitions, coordination of care)
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Quality Measurement &
Reporting: Disparities
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Measures of healthcare disparities are essentially
quality measures.
Disparities in health should not be a marginal or
special interest issue.
Need to determine which measures should be
routinely examined for disparities.
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1000 people
New Ecology
of Medical
Care
800 have symptoms
327 consider seeking medical care
217 visit a physician’s office
(113 to PCP)
65 visit CAM provider
21 visit a hospital OPD
14 receive home health
13 visit an ED
8 in a hospital
<1 in an academic
health center
NEJM 2000, Green et al
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Quality Measurement &
Reporting: Population
Health
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Need to consider how we begin to measure the
health of a population (align with emerging
measures of public health quality)
Need to increase linkages between healthcare and
public health systems
 Interconnected health IT systems should allow
for tracking of quality by population
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NQF
THE NATIONAL QUALITY FORUM
Questions/inquiries:
hburstin@qualityforum.org
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