Measure selection process

Performance Measurement For Quality ImprovementCCMS Measures Update- 11/9/06

1. CCMS Measures Project History and Update

1. Deborah Willis-Fillinger

   Mahyar Mofidi

   Amber Berrian

   Center for Quality

• 1. Performance Measurement for Clinical Quality Improvement

• •Thank Dr Duke 

   

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1. Meeting Objectives

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• CCMS- Measures History 

   

• Next to the Measure Details 

   

• CCMS Feasibility Study 

   

   

1. So here’s WHAT we will cover today.

 

1. Quality Health Care

• In 1990 The Institute of Medicine (IOM) defined Quality Care as: 

• 1. “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

 

1. Improving the Quality of Health Care
   Center for Quality – Action Steps (cont)

 

1. A Focus on Clinical Quality Improvement

• The purpose of Clinical Quality Improvement is to ensure that (HRSA) patients receive WHAT they need, WHEN they need it. 

   

• “The only way to know whether the quality of care is improving is to measure performance. 1 Institute of Medicine 

   

   

• Quality Improvement is a PROCESS.   

• • • • 1.                                    

• •Once again, this slide emphasizes that Quality Improvement is a PROCESS.   

• •We measure performance, we evaluate the results, we make incremental systems adjustments, and we measure again!   And so on and so on…….. Good Quality improvement occurs as the result of continuous observation measurement and change 

1. Next Slide

 

1. Core Clinical Measures Workgroup

1. CCMS/QRD

• **Deborah Willis-Fillinger, MD 

• *Margaret Lee, MD, MPH 

• *Mike Millman, PhD, MPH 

• Jill Ashman, MPH 

• Amber Berrian, MPH 

• Kathryn Cook 

• Charles Daly 

• Heather Dimeris, MPH 

• Nancy Egbert RN, MPH   

• Len Epstein, MPH 

• Tanya Grandison , MPH 

• Tracey Orloff, MPH 

• Tanya Pagan Raggio, MD, MPH 

• Jessica Townsend, MHCA  

• Jack Tenenbaum, PhD 

• Maribeth Badura, MSN, RN 

• Lisa Wright-Solomon, MPH 

   

1. ** Chair  * Co-Chair

• •Dr Margaret Lee from OPR- New York, is the co chair of the Cross Agency Workgroup. She was also a key contributor to the CMW Clinical Measures that were developed for OPR reviews in conjunction with the Bureau of Primary Health Care. 

• •CCMS- a rich collection of clinical, public health and data expertise. Many of the workgroup members have Quality Improvement expertise and a number of clinicians have clinical administrative experience and continue to practice in clinical settings with populations that HRSA supports through it’s grant programs. 

 

1. HRSA Level Measures Discussion

• • Promotes efficiency in planning and implementation of HRSA level quality initiatives 

     

  • Created agency level discussion of quality measurement 

     

  • Promotes collaboration around quality priorities and measurement 

     

  • Supports Bureaus in their quality initiatives 

1. So one could say that this meeting and discussion of clinical measures today is part of the overall road map initiative

 

1. Why HRSA Level Measurement?

• Alignment across HRSA is rare 

• Allows us to know whether we as an Agency are moving in the right direction 

   

• Provides foundation for HRSA level quality improvement initiative 

• Standardizes measurement- gives more meaning to quality discussions 

   

• Aligns HRSA with National performance measures  

   

   

   

   

1. Trends are important to assess when it comes to quality.

• •Notice that when approached from a HRSA level, we can identify opportunities to align measurement, to collect the same kinds of data. Ask the same questions the same way and limit the burden on grantees, many of whom receive funds from multiple HRSA programs, Bureaus, and Offices.  

• •HRSA Level Quality Improvement will allow different HRSA programs to share ideas and best practices across grantees working to accomplish the same or similar outcomes. 

• •Track trends in program performances and compare to national trends. 

 

1. Core Clinical Measures (CCMS)

1. Goal:

      Establish a standardized clinical measurement system for HRSA, to assist in the evaluation of HRSA program performance in defined clinical areas.

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• •These measures were first discussed in the context of the OPR performance reviews 

• •It was important to create a variety of measures that would allow each grantee choices to select, based on their program priorities, their communities and their data  capabilities.  

• •OPR’s grantee review process provided an opportunity to pilot some measures across a fraction of all of the HRSA programs. 

• •Not every measure will be appropriate for every grantee. 

• •There is probably at least one measure for everyone to choose to report on. 

   

 

1. What We Found

• HRSA has significant quality investments 

• Many programs focus on same or similar populations and health disorders 

• The measures for the same populations and focus were not aligned  

• Began a 12 month journey to develop a set of measures 

   

1. For Starters, this initiative looked at data requests that HRSA makes of grantees related to clinical care and sought to find some that could be aligned.

   A Cross HRSA Workgroup was developed to look at what was already being collected

• •CQ currently has a contract to do a Quality Initiatives inventory- this inventory focuses on clinical quality and will help us catalog our HRSA Quality investments.  

• •We realized that in developing HRSA wide strategies, it’s important to know what’s already there.  

• •Interview Bureau Office quality leads  

• •Discover approaches to quality improvement activities used by Bureaus and Offices 

• •Systematically identify quality initiatives, clinical assessment tools, tool kits, guideline development and other quality related activities of HRSA 

 

1. Some Challenges We Faced

• Data capability and retrieval limitations 

• Longitudinal measurement needed to demonstrate chronic disease control 

• Preventive care and screening requires documented follow up  

• Quality measures for office practices were not nationally established.  Those for plans, hospitals and populations often not useful or feasible for HRSA programs 

   

   

• •Data capability and retrieval limitations- Many grantees do not have EHR_ or Electronic patient management data. 

• •chronic disease control requires that we track patient outcomes over time 

• •Preventive care and screening requires documenting follow up and hand offs over time; what labs were done, what was the result, AND, what was done about it? 

• •When we began the process there were not many nationally established quality measures were ambulatory or office based practice. 

 

1. Some Challenges We Faced (Cont.)

• Disparities assessment and tracking requires demographic info, longitudinal tracking etc. 

• Data from sub-grantees problematic (e.g. Block grant, Title II etc.) 

• National quality indicators for systems development, and programs connecting people to care etc. are still lacking 

   

• •Many of our program grantees aren’t able to report demographic info about patients over time 

• •Data from sub-grantees is problematic (e.g. Block grant, Title II etc.) 

• •Systems development measures and connecting people to care measures are not yet tested and available 

 

1. CCMS Methodology

1. The draft clinical performance measures selected by CCMS:

• Apply to HRSA health service delivery programs 

• Are considered to be high priority clinical issues that relate to HRSA’s goal of reducing health disparities 

• Are aimed at improving the quality of health care by providing evidence based clinical measures and tools for HRSA grantees 

• Reflect both process and outcome measures 

• Address the different levels of bureau readiness/capacity to collect data 

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1. 
   CCMS Methodology (cont)

• Crosswalk  of clinical measures used within HRSA programs and Government Performance and Results Act (GPRA) 

   

• Clinical measures compared to those developed by 

• • National Committee for Quality Assurance (NCQA) 

     

  • Physician Consortium for Performance Improvement (PCPI) 

     

  • Centers for Medicare and Medicaid Services (CMS) 

     

  • National Quality Forum (NQF) 

     

  • Ambulatory Care Quality Alliance (AQA) 

 

1. Inclusion Methodology

• Relevance to HRSA Programs and populations 

• Importance to Bureau / Office programs  

• Scientific soundness 

• Feasibility- capacity of grantees to report measures 

• Application of measures for clinical/administrative decision making 

• Demonstrate progress towards HRSA/HHS strategic goals 

• • • 1.        

1.  

   The work that BPHC and OPR did on these measures is incredibly detailed.  ..

   We used that information, and searched for other measures that would be appropriate for our populations and programs

 

1. Inclusion Methodology (cont)

• Align with national measures such as (HEDIS, AQA, NQF, CMS) 

• Cover life cycles, prevention, chronic disease management 

• Eliminate duplication (ex: Cardio Vascular HTN, vs HTN for Diabetics) 

• • • 1.        

• •Developed a systematic approach/ methodology for identifying measures 

• •Reached Consensus on twelve measurement areas 

• •Recognized that measurement will be staged (short, mid, and long-range) to move toward better quality measures 

• •Covered public health priority areas, all life cycles, clinical care and prevention 

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1. CCMS Measures - 12 Clinical Areas

• Prenatal* 

• Newborn* 

• Immunizations* 

• Mental Health* 

• Oral Health 

• Diabetes* 

   

1. * Include Short range measures

• Cardiovascular* 

• Asthma 

• Smoke/Tobacco*  

• Healthy Weight 

• Cancer* 

• Behavioral Health*  

   

   

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1. The first list covered 12 different clinical areas.

   Measures were selected to:

• • Represent clinical care across all life cycles 

  • •Newborn, toddlers, children,  

  • •adolescents 

  • •Adults 

  • •Geriatric  

  • •Prenatal 

• •Focus on priority health issues and those that contribute significantly to health disparities 

  • •Diabetes 

  • •Cardiovascular 

  • •Oral Health 

  • •Mental Health 

  • •Prevention  

    • •Smoke/Tobacco 

    • •Cancer Screening 

    • •Healthy Weight 

    • •Behavioral risk assessments 

     

 

1. LIST OF CCMS MEASURES After HHQC Meeting in June.

• PRENATAL-First Trimester Care 

• CANCER SCREENING 

• • Breast Cancer  

  • Cervical Cancer  

  • Colorectal Cancer  

• DIABETES- A1C 

• IMMUNIZATIONS 

• • Children  

  • Adolescents  

  • Adults  

  • Older Adults/Geriatric  

  • HIV  

• NEWBORN SCREENING 

• BEHAVIORAL HEALTH-RISK ASSESSMENT 

• MENTAL HEALTH 

• PREVENTION 

• • Smoking Screening  

  • Smoking Cessation  

• CARDIOVASCULAR- HYPERTENSION 

• CARDIOVASCULAR- LIPIDS 

• • Lipid Screening  

  • Lipid Control  

• HIV PRENATAL SCREENING TEST*** 

 

1. Adopted Developmental Approach

• Short-range (< 12 months) “Today” 

• • Pilot implementation in CY 2007 

• Mid-range (12-24 months) “Tomorrow” 

• • Provides grantee and bureaus/offices with lead time         

• Long-range (> than 24 months) “Future” 

• • Critical measurements of clinical performance for HRSA programs and populations 

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• •The CCMS  recognized that this was a first step. A long term strategy for measures development has begun 

• •Adopted a developmental approach 

• •Pragmatic, based on assessment of current and future reporting capabilities 

• •Mid-range and long-range measures were selected: 

  • • to recognize that some grantees will be ready to report on these soon 

  • •To signal to HRSA grantees that the direction is toward more robust measurement 

     

   

1. .

 

1. Prevention

• PRENATAL  

• • First Trimester Care  

  • HIV Screening  

• CANCER SCREENING 

• • Breast Cancer  

  • Cervical Cancer  

  • Colorectal Cancer 

• IMMUNIZATIONS 

• • Children  

  • Adolescents  

  • Adults  

  • Older Adults/Geriatric  

  • HIV  

1. Chronic Disease Management

• DIABETES- A1C 

• CARDIOVASCULAR- HYPERTENSION 

   

   

   

   

1. • What We Heard From you about this process and these measures…

• • •Alignment with national standards supported 

  • •General acceptance of list of measures 

  • •Process for collecting data needs to be considered 

 

1. What We Must Consider

• • Messages are critical  

  • Measuring clinical quality is difficult 

  • Benchmarks & Baselines- compared to what? 

  • Finding common measures at HRSA was difficult 

  • There are unintended consequences of performance measurement 

    • in QI, outcomes often not “good” 

    • Shift of limited resources (time, funds etc) 

     

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1. Message-

• •careful NOT to suggest that these are the ONLY important issues 

• •Long term process, not all measures applicable, not all grantees capable of reporting data YET 

1. Unintended Consequences

• •If “Not good” is real, it’s still “OK” as a place to start improvement 

• •Truth can hurt, deception looks better, but not useful if quality outcomes is the goal. 

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1. What We Heard

• Missing/future measures 

• •  

  • Oral health 

  • Mental health 

  • Obesity 

  • Newborn 

     

 

File Type	application/vnd.ms-powerpoint
File Title	Quality Roadmap
Author	HRSA
Last Modified By	HRSA
File Modified	2007-07-31
File Created	2006-06-01