Anatomy & Physiology of the
National Quality Forum
JO ANN BROOKS PHD, RN, FAAN, FCCP
SYSTEM VP, QUALITY & SAFETY
INDIANA UNIVERSITY HEALTH
Conflict of Interest Disclosures
 Member, Steering Committee, NQF Admissions &
Readmissions
 Others not related to this presentation
 Cadence Pharmaceuticals—speaker’s bureau
 Abbott Nutrition—speaker’s bureau
Objectives
Describe the history, mission & vision of the NQF
2. Identify how the NQF fits into the CMS Triple Aim, the
National Quality Strategy & health information
technology (EHR, eMeasures, etc)
3. Describe the criteria for the development of a
performance measure & the process for endorsement
4. Identify how an individual or NQF member may actively
participate in the work of the National Quality Forum &
stay informed on present & future performance measures
1.
What ‘clinical quality’ really means in
2014
Most providers don’t know the level of quality they
provide, but assume it’s excellent
2. External-agency quality awards are imperfect and
sometimes misleading indicators of quality
3. Even government-sanctioned core measures are
highly imperfect indicators of quality
1.
Care Transformation Center Blog, Jim Field;
March 5, 2014
1998
 President's Advisory Commission on Consumer
Protection & Quality in the Health Care Industry
 State of Health Care Quality
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Avoidable errors
Underuse of health care services
Overuse of services
Variation in services
 National commitment needed to the measurement,
improvement & maintenance of high-quality health
care
Historical Aspects NQF
 1999 Incorporated 501(c)-3
 2002 First set of endorsed standards SREs
 2007 Endorsed measures 250
 2009 HHS contract
1999
 NQF created by coalition of public & private-sector
leaders in response to commission report
 Private, non-profit, voluntary consensus standards
setting organization
 Today received funding from public & private
sources
 In 2009 received DHHS contract
NQF & HHS Contract
 Four year contract 2009-2013
~$40 million
 Work on five domains:
 Recommendations on national strategy & priorities
 Endorse quality measures
 Maintain quality measures--update or retire
 Promote EHR
 Report annually to Congress
Mission
• Building consensus on national priorities &
goals for performance improvement and
working in partnership to achieve them
• Endorsing national consensus standards for
measuring & publicly reporting on
performance
• Promoting the attainment of national goals
through education & outreach programs.
Vision
 To be the convener of key public & private sector leaders to
establish national priorities & goals to achieve healthcare
that is safe, effective, patient-centered, timely, efficient &
equitable
 NQF-endorsed standards will be the primary standards
used to measure & report on the quality & efficiency of
healthcare in the United States
 To be a major driving force for & facilitator of continuous
quality improvement of American healthcare quality
 Organization comprised of many different voices,
ideas, and thoughts coming together. The cause of
making healthcare both safe and affordable, and
people healthy, cuts across a wide variety of
different stakeholders
Governance & Leadership
 CEO Dr. Christine Cassel, MD
 Board of Directors
 Board Committees
 Consensus Standards Approval Committee
 Health IT Advisory Committee
 Leadership Network
 National Priorities Partnership
 Measure Applications Partnership
 Member Councils
Unique Features
 Open membership
 Public & private sector representation
 Attention to overall strategy for measuring &
reporting healthcare quality
 Focus is the entire continuum of healthcare
 Has a formal consensus process
NQF Membership
 Consumer Organizations
 Health Plans
 Health Professional Organizations
 Public & Community Health Organizations
 Hospitals, Health Systems
 Industry
NQF 2013 Report to Congress
 Continued recommendations for the National
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Quality Strategy & Priorities
Quality & efficiency measurement initiatives
(performance measures)
Stakeholder recommendations on quality &
efficiency measures (MAP)
Gaps in endorsed quality & efficiency measures;
evidence & targeted research needs
Consensus Development Process
National Quality Strategy & Priorities
2010
 Request of HHS, convened the National Priorities
Partnership (PPS) that helped shape the initial
version of the National Quality Strategy
 National Priorities Partnership (co-chairs Don
Berwick MD & Margaret O’Kane)
 Provided roadmap for:
 Achieving better, more affordable care and better
health
National Priorities Partnership
 The NPP is a partnership of 52 major national
organizations with a shared vision to achieve better
health, & a safe, equitable & value-driven healthcare
system.
Copyright ©2014 NQF
Priorities
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6.
Making care safer by reducing harm caused in the delivery
of care
Ensuring that each person & family is engaged as
partners in their care
Promoting effective communication & coordination of
care
Promoting the most effective prevention & treatment
practices for the leading causes of mortality, starting with
cardiovascular disease
Working with communities to promote wide use of best
practices to enable healthy living.
Making quality care more affordable for individuals,
families, employers, and governments by developing and
spreading new health care delivery models
Supporting Partnership for Patients
 Developed action teams
 Reducing preventable inpatient harm
 Reducing readmissions for complex & vulnerable populations
 Engaging patients & families in health systems improvement
Patient Focused Episode of Care Model
Copyright ©2014 NQF
Patient Focused Episode of Care Model
Copyright ©2014 NQF
Quality & Efficiency Measurement
Initiatives
Quality & Efficiency Measurement
Initiatives
 Since 1999 developed over 700 NQF-endorsed
measures across continuum
 Current state
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Focus on “maintenance” process
Review previous & newly endorsed measures
Relevancy – review all measures in an area
Harmonization
 2013 added 27 new measures; removed 95
NQF Measure Portfolio
Measure Steward
# of Measures
Percent
CMS
117
17%
NCQA
104
15%
PCPI
94
14%
AHRQ
56
8%
Resolution Health
23
3%
The Joint Commission
22
3%
ActiveHealth Mgmt
22
3%
Copyright ©2014 NQF
Copyright ©2014 NQF
Copyright ©2014 NQF
Other Work
 Advancing Measurement Science
 Evaluating composite measures
 eMeasure feasibility
 Measurement Endorsement
 Pulmonary & critical care
 Neurology
 Infectious disease
 Patient safety
eMeasure Feasibility
 More clarity needed about testing
 NQF identified 7 feasibility recommendations
 Report provides guidance to help guide future of
eMeasure development, testing & certification
Future Endorsement Work
 Admissions & readmissions
 Endocrine
 CV
 Care coordination
 Person-family centered care
 Episode groupers from administrative claim data
 Risk adjustment for performance measures
 Work with AHRQ to develop common formats of
SREs
Measure Applications Partnership
Measure Application Partnership
 Launched April 7, 2011
 Public-private partnership
 Serve as the neutral convener of multi-stakeholder groups
that will provide input on selecting measures for use in
federal public reporting & performance-based payment
programs
 Provides feedback for >20 federal public reporting &
performance based pay programs PRIOR to rule making
Building Blocks to Efficiency & Value
Copyright ©2014 NQF
MAP
Copyright ©2014 NQF
MAP
Copyright ©2014 NQF
Distribution by NQS Priority of Measures
in HHS Programs 2/2013
Copyright ©2014 NQF
Gaps
Gaps
 Adult immunization
 Alzheimer’s disease & related dementias
 Care coordination
 Health workforce
 Person-centered care & outcomes
Other Measure Gaps
 Goal-directed, person-centered care planning
 Shared decision making
 Systems to coordinate care outside the hospital
 Beneficiary sense of control/self-determination
 Psychosocial needs
 Community integration
 Optimal functioning
Consensus Development Process
Consensus Development Process
Copyright ©2014 NQF
Evaluation Criteria
 Impact, opportunity & evidence—importance to
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measure
Performance gap
Reliability, validity
Usability
Feasibility
Also
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Measure based on data from electronic source
Clinical data from EHRs
Measures which are freely available
Reduce Avoidable Readmissions
Copyright ©2014 NQF
Present Ongoing NQF Projects (4/2014)
 Admissions/Readmissions Steering Group
 Audit of 2010 Safe Practices for Better Healthcare
 Surgery Measure Evaluation
 Adult Immunization Group
 Patient & Family Engagement Action Team Web Mtg
 Care Coordination Measures
 Behavioral Health Measures
Resources
 Field Guide to NQF Resources
 Phrase book for NQF jargon
 The ABCs of Measurement
Working with NQF
 Membership, nonmember access
 Stay engaged & current on measures under review
 Submit comments during public comment period
 Utilize resources
Future of Quality Measurement
 Potential Roadmap for the Transition
 Feasible
quality measurement implementation
that minimizes burden
 Common platform that serves multiple
stakeholders
 Align measures around patient-centered
outcomes across the continuum
Conway, PH; Mostashari, F, Clancy, C. (2013). The future of
quality measurement for improvement and accountability. JAMA
309(21); 2215-2216
Future of Quality Measurement
 Strategic Shifts
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Complexity of clinical data may need to be minimized; how can
data elements be captured as part of routine clinical workflow
Automated systems need to be established to collect patientreported outcomes & experience of care
Increased interoperability & data liquidity
Increased reliability of quality measure calculation across
health IT systems
Goal of measurement is improvement!
Conway, PH; Mostashari, F, Clancy, C. (2013). The future of quality
measurement for improvement and accountability. JAMA 309(21);
2215-2216
From: The Future of Quality Measurement for Improvement and Accountability
JAMA. 2013;309(21):2215-2216. doi:10.1001/jama.2013.4929
Date of download: 4/14/2014
Copyright © 2014 American Medical
Association. All rights reserved.
Malcolm T. MacEachern, MD
“Never the less, our hospitals are now involved in the
worst financial crisis they have ever experienced. It is
absolutely necessary that all of us put our heads
together and try to find some solution…. Everything
possible has been done to reduce expenditures, but
this has not been sufficient to bring about the
immediate relief in the majority of instances…”
Source
The Bulletin of the American Hospital
Association
Vol VI, No 7; July 1932
“Some Economic Problems Affecting
Hospitals Today and Suggestions for their
Solution”