A Perspective from the Co-Chairs of the: National Quality Forum Prevention Endorsement Maintenance Steering Committee

Transcription

1 A Perspective from the Co-Chairs of the: National Quality Forum Prevention Endorsement Maintenance Steering Committee Paul Jarris, MD, MBA Executive Director Association of State and Territorial Health Officials Kurt C. Stange, MD, PhD Professor of Family Medicine & Community Health, Epidemiology & Biostatistics, Oncology & Sociology Gertrude Donnelly Hess, MD Professor of Oncology Research Director, Residency in Preventive Medicine & Public Health Case Western Reserve University American Cancer Society Clinical Research Professor Editor, Annals of Family Medicine Promoting Health Across Boundaries

2 Overview NQF Population Health Endorsement Maintenance Steering Committee Context Process Recommendations Lessons Challenges Opportunities 2

3 National Quality Forum Population Health Endorsement Maintenance Project Thanks to: Elisa Munthali, MPH Senior Project Manager, Performance Measures

4 NQF Introduction Non-partisan, non-profit established in 1999 Mission to improve the quality of American health care by reviewing, endorsing and recommending performance measures Public Private Collaboration Board and 450 plus members 4

5 NQF s Primary Roles Standard setters review & endorse Measures, serious reportable events, preferred practices Neutral conveners offer advice to HHS and build consensus across the public and private sectors and diverse stakeholder groups National Priorities Partners (NPP) Measure Application Partnership (MAP) 5

6 NQF s Measure Evaluation Criteria Importance to measure and report What is the level of evidence for the measures? Is there an opportunity for improvement? Relation to a priority area or high impact area of care? Scientific acceptability of the measurement properties What is the reliability and validity of the measure? Usability and Use Can potential audiences use performance results for both accountability and performance improvement? Feasibility Can the measure be implemented without undue burden, capture with electronic data/ehrs? Assess related and competing measures 6

7 NQF s Population Health Endorsement Maintenance Project Initiated in fall 2011, with HHS contract, NQF s first consensus development project primarily focused on population-level performance measurement Large focus on updating 33 clinical preventive services New focus on call for population health measures Commissioned paper from LA Health Department Convened multi-stakeholder committee Developed measure evaluation guidance Developed guidance for measure developers Developed Call for measures Evaluated measures 7

8 Priorities for the National Quality Strategy From the Population/Community Health Subcommittee: Promote healthy living and well-being through community interventions that result in improvement of social, economic, and environmental factors. Promote healthy living and well-being through interventions that result in adoption of the most important healthy lifestyle behaviors across the lifespan. Promote healthy living and well-being through receipt of effective clinical preventive services across the lifespan in clinical and community settings. 8

9 Inclusion of HHS Public Health Quality Aims in NQF s Population Health Measure Evaluation Guidance Population-centered Equitable Proactive Health promoting Risk reducing Vigilant Transparency Effective Efficient 9

10 National Prevention Strategy and DHHS Consensus Statement on Quality in Public Health and NQF s Measure Evaluation Guidance Review/relevance of NQF s measure evaluation criteria Changes related to Denominator Upstream determinants Health equity High Impact subcriteria» Need to explicitly characterize public health quality improvement to help guide measure developers and reviewers Nomenclature (e.g. clinical references) Responsible entity 10

11 Call for Population Health Measures - Development Call for Measures developed by Committee, with input from NQF Integrated priority areas for healthy living & well-being from NQS and NPP Focused on community interventions that result in improvement of social, economic, and environmental factors and interventions that result in adoption of healthy lifestyle behaviors across the lifespan Informed by commissioned paper on population health» Environmental scan of existing measures and gaps» Conceptual frameworks on population health, determinants of health and improvement activities Developed with several iterations with input from the CSAC Posted April 2-May 1 (30-days) 11

12 Call for Population Health Measures - Outreach Conducted prior to and during Call for Measures Committee members» Field test to external colleagues» Individual outreach (meetings, webinars etc.) NQF» Monthly Developer webinars» Member Council meetings» Member communications» One-on-one calls/meetings with potential submitters» Leadership discussions with external partners 12

13 NQF Call for Measures Health outcomes - Health outcomes of individuals, including health/functional status, mortality, & quality of life; - Measures that assess the health of a total population or a subset of a population (subpopulation), including disparities across the population. - Measures that cover the lifespan, - children, adolescents, and the elderly. Determinants of health - Adoption of healthy lifestyle behaviors; Population-level measures in the following priority areas encouraged: Overweight/obesity; Physical activity; Tobacco use (e.g., screening, smoking cessation); and Nutrition - Receipt of health promotion and education services; - Modifiable social, economic, and environmental determinants of health with demonstrable relationship to population health outcomes. 13

14 Call for Population Health Measures Response Few submissions endorsed 5 measures healthy lifestyle behaviors and broader population health measures Barriers to submitting: Short turn-around Testing not complete or uncertain about testing requirements Lack of resources staffing and time to gather information and/or complete submission form, or testing Competing priorities Uncertainty about relevance/benefit 14

15 NQF-Endorsed Population Health Measures 1999: Late HIV diagnosis 2020: Adult Current Smoking Prevalence 0421: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up 0024: Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents 0029: Counseling on physical activity in older adults - a. Discussing Physical Activity, b. Advising Physical Activity 15 1

16 Committee Evaluation The Steering Committee cited four major issues with the recent Call for Measures: 1. Low volume of submitted measures 2. Quality of measures and level of analysis a. Measures, including those under maintenance review, were primarily clinically-focused. b. None addressed upstream determinants of health. 3. Arduous submission process & confusion around the evaluation process a. Several developers expressed frustration about the submission process. b. Due to timing and other constraints, online submission forms were not updated to reflect the Committee s guidance for evaluating populationlevel measures, although the material was available as attachments or supplemental guidance. 4. Lack of clarity about the value proposition of NQF endorsement for public and community health organizations 16

17 Challenges Differing lenses & cultures Public health Clinical health care systems How do we define population? Patients served Geopolitical jurisdiction Community with identity 17

18 Accountability Patient served empaneled geopolitical Measurement Sum of individual records vs. population survey Purpose of measures Accountability & performance vs. epidemiology Relationship to NQF Measure Developers Challenges 18

19 Opportunities Harmonize measures across/between clinical and population health Define relationship between patients served, market share and geopolitical populations Explore shared influence and accountabilities Explore aligned incentives and rewards e.g. positive incentives for ACOs to focus on geopolitical communities and socially-deprived 19

20 Opportunities Develop comprehensive measure sets Structure, process and outcomes Clinical to behavioral to environmental and policy interventions Expand and enhance the relationship between clinical & population/public health (? & NQF) Outreach Governance, management, committees Invest in population health measure developers Invest in and integrate systems Vital records EHRs 20

21 Opportunities Raise the gaze from Health care access, to Aggregate clinical measures, to Whole person/family function, HRQOL & social role fulfillment, to Social, environmental determinants, to Equity, to Sustainability / evolvability Multistakeholder shared influence and accountability 21

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23 Extra Slides (For possible use during discussion)

24 Measurement Public Health Data Accountability Clinical Data 24

25 Affordable Care Act Opportunities Community Transformation Grants Community Health Needs Assessments Medicaid Preventive Services Community Health Centers National Prevention, Health Promotion & Public Health Council & the National Prevention Strategy CMS Innovation Center Accountable Care Organizations Patient-Centered Medical Homes Primary Care Extension Program National Health Service Corps Teaching Health Centers IOM Committee on Integrating Primary Care and Public Health. Exploring Integration to Improve Population Health. Washington: National Academies Press,

26 The Measurement Imperative Not everything that counts can be counted, and not everything that can be counted counts But.. ~Albert Einstein You can t improve what you don t measure ~ W. Edwards Deming 26

27 NQF-Endorsed Population Health Measures Measures not recommended 2014: Place of Birth 2018: Year of arrival to the United States (for the foreign born) 0023: Body Mass Index (BMI) in adults > 18 years of age 1690: Adult BMI Assessment 27

28 C mon, c mon. It s either one or the other. 28

29 Paper or plastic? 29