Build­ing con­sen­sus on what re­ally counts

Modern Healthcare - - COMMENT - By Dr. Chris­tine Cas­sel

Iam of­ten asked to ad­dress the chal­lenges that the growth of mea­sure­ment and ac­count­abil­ity re­quire­ments pose for the im­por­tant goal of health­care qual­ity im­prove­ment. My think­ing here has evolved over time.

The field has grown tremen­dously since 1998, when the Pres­i­dent’s Ad­vi­sory Com­mis­sion on Con­sumer Pro­tec­tion and Qual­ity in the Health Care In­dus­try, on which I served, rec­om­mended the cre­ation of the Na­tional Qual­ity Fo­rum. We have come a long way in 15 years, from a time when there were too few qual­ity mea­sures, to a time when nu­mer­ous ob­servers think there are too many.

In 1999, when the NQF—the mul­ti­stake­holder group that re­views and en­dorses mea­sures used to as­sess per­for­mance—be­gan its work, there were just a few stan­dard­ized qual­ity mea­sures in limited use.

There are now more than 600 NQF-en­dorsed mea­sures on a wide range of is­sues, from re­duc­ing hospi­tal-ac­quired in­fec­tions, to pro­vid­ing bet­ter care for moth­ers and ba­bies, to im­prov­ing treat­ment for chronic con­di­tions such as di­a­betes. We’re now hard at work on the next chal­lenge: bring­ing health­care stake­hold­ers to­gether to iden­tify a small group of high-im­pact, high-lever­age core mea­sures for providers to broadly use, pub­licly re­port and link to pay­ment.

Ini­tial ex­pan­sion of mea­sure­ment cri­te­ria was a nec­es­sary step in an evolv­ing qual­ity-im­prove­ment land­scape. How­ever, the pro­lif­er­a­tion of mea­sures has made it tough for providers to keep up with reporting re­quire­ments, while cre­at­ing con­fu­sion for pa­tients. By forg­ing an agree­ment about the most use­ful mea­sures and in­ter­ven­tions, we can re­duce reporting bur­dens, has­ten im­prove­ments and give pa­tients com­pa­ra­ble in­for­ma­tion to make in­formed de­ci­sions.

For ex­am­ple, in Jan­uary 2012 the NQF con­vened a group that in­cluded the Amer­i­can Col­lege of Ob­ste­tri­cians and Gy­ne­col­o­gists, the Amer­i­can Hospi­tal As­so­ci­a­tion, the Joint Com­mis­sion and the March of Dimes to agree on a stan­dard­ized qual­ity-im­prove­ment in­ter­ven­tion and mea­sures to re­duce harm­ful, costly, early elec­tive de­liv­er­ies. Na­tion­wide, those de­liv­er­ies de­creased by half be­tween 2012 and 2013.

I’m proud of the tremen­dous growth and evo­lu­tion of qual­ity mea­sure­ment since 1999 and in­vite oth­ers to join me in tack­ling the next big chal­lenge: build­ing con­sen­sus around mea­sures and in­ter­ven­tions that im­prove pa­tient care and the health of all Amer­i­cans. To get that right, we need ev­ery­one at the ta­ble, fo­cused on the value of one goal: bet­ter care at lower cost.

Dr. Chris­tine Cas­sel is pres­i­dent and CEO of the Na­tional Qual­ity Fo­rum, Wash­ing­ton.

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