By David Yucht, J.D.
TheNational Quality Forum, a consensus-based entity (CBE) retained by HHS to improve health care performance measurement, provided its Report of 2016 Activities describing the implementation and coordination of measurement initiatives, recommendations, gaps in existing quality and efficiency measures, and additional information (Notice, 82 FR 39797, August 22, 2017).
National Quality Forum. The HHS Secretary is required to retain a (CBE) to help improve health care performance measurement. In January 2009, the National Quality Forum (NQF) was retained as the CBE. The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) expanded the CBE’s duties requiring it to convene multi-stakeholder groups to provide input on the selection of quality and efficiency measures and to transmit such input to the Secretary via an annual report.
Highlights. NQF reported that in 2016, it updated its portfolio of approximately 600 endorsed measures by reviewing and endorsing 197 measures and removing 87 measures. These endorsed measures involve many topics, including: person and family-centered care; care coordination; palliative and end-of-life care; behavioral health; pulmonary/critical care; cancer treatment; patient safety; and cost and resource use. Additionally, NQF reported that in 2016 it continued to support the National Quality Strategy (NQS) by endorsing measures linked to the NQS priorities and convening diverse stakeholder groups to reach consensus on strategies for performance measurement. NQF also undertook projects to address quality measurement issues and reduce the burden of quality measures for clinicians. An important area that NQF continued to address was the process used to assign accountability for a patient and his or her quality outcomes to a clinician, a group of clinicians, or a facility. NQF identified 171unique attribution models, 27 of which have been implemented and 144 remained proposals.
NQF recommendations. Among the 2016 recommendations were those centered on population health and home- and community-based services. Concerning population health, the report referenced NQF’s three-year study: Improving Population Health by Working with Communities: Action Guide 3.0. This study identified 10 elements for improving performance measurement of population health:
- collaborative self-assessment;
- leadership across the region and within organizations;
- audience specific strategic communication;
- a community health needs assessment and asset mapping process;
- prioritized health improvement activities;
- selection of measures and performance targets;
- joint reporting on progress towards achieving intended results;
- indications of scalability; and
Regarding the assessment of home- and community-based services, the NQF issued short-, intermediate-, and long-term recommendations. Among short-term recommendations were the use of quality measuring tools related to falls, medications and immunizations; assessing the scientific acceptability and expanding the use of existing quality measures related to housing and homelessness and expanding measure concepts to meaningful activity in the community. Intermediate-term recommendations included focusing on greater tool and resource development such as person-centered outcome measures. In the long-term, NQF recommended infrastructure and system reform including developing processes needed to collect data related to home care.
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