Pilot Site

1. Patient-reported Outcome Functional Status Assessment (PRO FSA) Heart Failure Measure Testing Project

1. <Site name>

   <Month, date, year>

 

1. Agenda

1. 1.Introductions and Project Overview 

2. 2.Workflow processes (and related electronic or paper forms) and Measuring/ Monitoring activities 

3. 3.Use case scenario and questions 

4. 4.Focus Group Discussion 

• • –General questions 

  • –Presentation of measure 

  • –Technical/ EHR Feasibility and considerations 

1. 5.Forms/Questionnaire Completion 

2. 6. Adjourn 

 

1. Purpose

1. Our goal for this focus group is to discuss:

• 1. 1.        Framework for measure

     2.        Feasibility of implementation including workflow         processes and technical implementation of the         measure concepts

• 1. 3.Key aspects of clinical data for measuring goal setting and achievement in conjunction with patient- reported functional status assessments 

 

1. Measure Testing Objectives:
   Feasibility and Face Validity

• 1. 1.Obtain comprehensive input to inform the measure from care providers on the front lines of conducting patient-reported functional status assessments with heart failure patients  

  2. 2.Increase usage of patient-reported outcome measures to monitor disease activity, assess functional status, and goal setting with patients 

  3. 3.Reinforce the delivery of patient-centered care 

  4. 4.Improve outcome measures to accurately assess the quality of clinician performance and provide clinicians with data to promote quality improvement 

  5. 5.Determine the current and future feasibility of outcome measures to track patient-reported functional status over time using data from EHRs 

 

1. Organization representatives who were consulted during development of the ONC HITECH PRO FSA Heart Failure Measure

• •American Association of Cardiovascular and Pulmonary Rehabilitation 

• •American Heart Association 

• •American College of Cardiology 

• •American College of Physicians 

• •American Society for Echocardiography 

• •Foundation for Informed Medical Decision Making 

1. - Participated in formal workgroup

 

1. Heart and chronic heart failure identified as national priority by:

• •ONC HITECH  

• •Centers for Medicaid and Medicare Services (CMS) (http://www.facs.org/ahp/pqrs/2013/ehr-measure-release.pdf)   

• •Agency for Healthcare Quality (AHRQ) (http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/nhdr11.pdf) 

• •National Quality Forum (NQF) National Priorities Partnership (NPP National Priorities & Goals, www.nationalprioritiespartnership.org) 

• •The Joint Commission (TJC’s Annual Report on Quality and Safety 2013, http://www.jointcommission.org/assets/1/6/TJC_Annual_Report_2013.pdf) 

• •The Dartmouth Institute, Dartmouth-Hitchcock Hospital (http://patients.dartmouth-hitchcock.org/quality/quality_report/HF)  

   

 

1. <This would be nice to include, could someone provide this type of context/ info in 1 slide here?>

• •Gaps in care – eg, the report finding that the availability of a discharge summary at the first post-discharge visit is only 12-34%, affecting the quality of care in approximately 25% of follow-up visits (JAMA 2007) 

• •High costs – eg, the Institute of Medicine estimate that inpatient and outpatient medication errors harm 1.5 million people each year in the United States, at an annual cost of at least $3.5 billion (NY Times 2006), and one study finding that 60% of inpatient medication errors occur at times of transition (J Clin Outcomes Manag 2001) 

   

 

1. Framework for Patient Goal Setting and Goal Achievement
   

 

1. Framework for Patient Goal Setting and Goal Achievement
   

 

1. Draft Measure Description

1. Patient-reported Functional Status Assessment (PRO FSA) Heart Failure Measure:

1. Percentage of patients age 65 years and older with heart failure who completed initial and follow-up PR-FSA, who set a goal using the initial FSA and who achieved that goal according to follow-up FSA

 

1. Draft Patient-reported Functional Status Assessment (PRO FSA) Heart Failure Measure Components

1. Denominator:

• •Adults age 65 and older who had two outpatient encounters during the measurement period and an active diagnosis of Stage C or Class II, III heart failure 

1. Denominator Exclusions:

• •Patients with an active diagnosis of severe cognitive impairment or cancer. Patients with Stage D or Class IV heart failure 

1. Numerator:

• •Patients with results from at least two patient reported functional status assessments, who set a goal using the initial FSA and who achieved that goal according to follow-up FSA 

   

   

 

1. Future Work

• •Revise the measure specifications based on today’s feedback 

• •Testing results needed for National Quality Forum (NQF) endorsement: 

• • –Is the measure feasible? 

  • –Is the measure reliable? 

  • –Is measure valid? 

  • –How is measure used in practice? 

• •Testing results needed to inform workgroup 

• •All of the above, plus: 

• • –How is the measure being implemented? 

  • –Where are the data necessary to calculate the measure found? 

  • –Are the measure data typically captured using codified data or free text 

 

1. <BAH> Timeline of future work

 

1. Thank you!

• 1. Questions?

     Meredith Jones, MPH

     [email protected]

     (312) 464- 4923

• 1. <Additional contact information of presenters>

 

1. Functional Status Assessment Tools

• •VR-12 

• •VR-36 

• •PROMIS-Global 10 (not yet validated in HF population, growing body of research for use in chronic disease populations) 

• •PROMIS-29 (not yet validated in HF population, growing body of research for use in chronic disease populations) 

• •MLHF-Q (21 questions; reliable, valid, and responsive in this population; proprietary. Fee is associated with use) 

• •KCCQ (23 questions; reliable, valid, and responsive in this population; proprietary. Fee is associated with use) 

• •SF-12 (Proprietary) 

• •SF-36 (Proprietary) 

• •EQ-5D (Utility measure; not appropriate for goal setting) 

 

1. ACC/ AHA Stages of Heart Failure

• •Stage A: At high risk for HF but without structural heart disease or symptoms of HF 

• •Stage B: Structural heart disease but without signs or symptoms of HF 

• •Stage C: Structural heart disease with prior or current symptoms of HF 

• •Stage D: Refractory HF requiring specialized interventions 

• • –PROPOSED FOR THIS MEASURE:  

    • •VR-12, PROMES-Global 10, MLHF-Q, KCCQ 

1. Reference as needed.

 

1. NYHA Classification

1. Functional Capacity

1. Class I. Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain.

1. Class II. Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.

1. Class III. Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain.

1. Class IV. Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.

1. Objective Assessment

1. A. No objective evidence of cardiovascular disease.

1. B. Objective evidence of minimal cardiovascular disease.

1. C. Objective evidence of moderately severe cardiovascular disease.

1. D. Objective evidence of severe cardiovascular disease.

 

1. Key Data Elements in Patient-reported Functional Status Assessment (PR FSA) Heart Failure Measure  

• •Class of Heart Failure (I, II, III, IV) 

• •Initial FSA result 

• •Follow-up FSA result 

• •Patient goals 

• •Severe cognitive impairment 

• •Cancer stage (A, B, C, D) 

   

 

File Type	application/vnd.ms-powerpoint
File Title	PilotSitePowerPoint 3_14_14
Author	American Medical Association
Last Modified By	Funn, Sherrette (OS/ASA/OCIO/OEA)
File Modified	2014-05-01
File Created	2009-12-03

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