Primary Care Quality Reporting (PCQR) Collaborative Project Design Team June 4, 2013 Work Session (Virtual) 8:00-9:00 AM Record of Learning Participating Design Team: Parminder Bajwa MD, John Davis, Vicki Diller, Sarah Durfee , Diana Riggsby Gardner, Lisa Kaiser, Christine Lester, Michelle Love, Bruce Wall MD Access HealthColumbus: Jeff Biehl, Carol Deibel, John Leite Objectives 1- Update design team on project’s commitments. 2- Obtain design team input into report design. TOPIC Review & Update
NOTES o
o
Work Session – Report Design
o
o
o
ACTION ITEMS
Review project current design Carol reviewed slides and content of design and path for 2013 Update on practices committed to data sharing Carol reviewed that seven organizations have committed to data sharing with 79 practice sites Invitation and acceptance will continue through July for 1st version participation Information for report display Carol reviewed the set of Non-Clinical information and Clinical Measures being collected from participating practices Report design considerations were reviewed: ‘at a glance’ elements, explanations, and the project’s design and intent Layout Samples A1 & A2 Single practice site, all measures A1- contains result displayed with local and national average and A2- contains result displayed with local and national averages and local percentiles Design Questions with voting on A1 versus A2
o
Layout Sample B Single measure, all practices Use of four payer groups defined as the predominant payer(s) of the practice site (Commercial, Commercial+Medicare, Self Pay+Medicaid>33%, Self Pay+Medicaid) Practices in alphabetic order Practices in results order (high to low distribution)
o
Design Questions with voting on B (usefulness, payer 1
The group felt A1 was useful and simple to read, preferred it over A2. The inclusion of the description of the measures’ clinical importance in the A reports was recommended.
The group felt that B was useful. Use of payer grouping should be reviewed, using three payer groups: Commercial, Commercial+Medicare, Self Pay+Medicaid A specific % definition of the payer volumes should be used. Preferred use of practices in alphabetic order. Additional consideration for inclusion of the results order when actual data is available (Does it add value? Does it encourage practices in quality improvement?).
TOPIC
NOTES
ACTION ITEMS
groups, practice order views) Closing and Next Steps
Next design team work session is tentatively scheduled for 8/6 as a virtual call again 8:00-9:00 AM. Subsequently the next design team work session will be planned in November when report preview can occur.
2
AHC will share work session Record of Learning, proceed with project invitation and data collection coordination, and use this work session’s input in the report designs (see attached).
SAMPLE A FICTICIOUS DATA
Primary Care Quality Report – Version 1.0 Primary Care Practice: xxx Practice Site 2222 Address St., City, OH xxxxx
Primary Care Quality Reporting Project Purpose – Primary care is front and center in an effort to improve the value of health care in our country. Many communities have advanced with transparent primary care quality reporting. A local multi-stakeholder collaborative formed in the fall of 2012 to implement this transparent all-patient local prototype of Primary Care Quality Reporting in 2013. The collaborative intends for this prototype to advance Central Ohio reporting readiness for future primary care quality improvement and demonstration. This project contributes to aims for better health, care, and value supporting continuous improvement driven by data, including: Coordination of care across the medical neighborhood Optimal use of health information technology Planned care for chronic conditions & preventative care This report is the first of quarterly reports through 2014. Collaborative participants are invited to view this report under the Participant Terms of Use (see Attachment A). Participants are those organizations that provide data, view or review reports. Thank you xxx Practice Site for participating in sharing your data with the collaborative.
Payer Mix xxx Practice Site
Medicare
Medicaid
10% 2% 35%
Medicar e
5% 2%
Medicai d
Commerci al
38% 15%
Payer Mix All Practices
Commer cial
25% 58%
Patient Age xxx Practice Site
10%
Self Pay/Uni nsured
Self Pay/Unins ured
22% 78%
Children under 18 Adult
Payer mix is displayed to provide some insight into the revenue sources and patient types of the practice site. The quality reports are not case mix adjusted.
3
Primary Care Quality Report Primary Care Practice: xxx Practice Site Adult Patient Quality Measures (summary descriptions & rationales in Attachment B) Diabetes Patient Measures (National Quality Forum # 0064, 0061, 0059) Diabetes: Cholesterol Control 80%
Diabetes: Blood Pressure Management
Diabetes: Poor Blood Sugar Control (lower is better)
80%
20%
60%
15%
40%
10%
20%
5%
60% 40% 20% 0%
LDL<100
xxx
PCQR C OH
Nat'l Comp arativ e
70%
57%
65%
0%
BP<140/90
xxx
PCQR C OH
Nat'l Com parat ive
70%
75%
66%
Controlling High Blood Pressure
Appropriate Medications for Asthma
(National Quality Forum #0018)
(National Quality Forum #0036)
Patients with Hypertension Managed
Appropriate Asthma Medications
80%
100%
60% 40%
95%
20% 0%
BP<140/90
xxx
PCQR C OH
Nat'l Com parat ive
77%
70%
72%
90%
Ages 18-50
xxx
PCQ RC OH
Nat'l Com para tive
98%
97%
95%
4
0%
A1c>9%
xxx
PCQR C OH
Nat'l Comp arativ e
11%
14%
17%
NOTES 1- PCQR C OH -Primary Care Quality Reporting Central Ohio Average 2- All data sourced from Electronic Medical Records and was selfreported by medical practices 2- Diabetes Patient Ages are 18-75 3- High Blood Pressure patient ages are 18-85 4- Asthma patient ages are 18-50 5- Measurement period was 3rd quarter 20122nd quarter 2013
Primary Care Quality Report Primary Care Practice: xxx Practice Site Pediatric Patient Quality Measures (summary descriptions & rationales in Attachment C) Appropriate Medications for Asthma (National Quality Forum # 0036) Asthma Patients 5-11
Asthma Patients 12-17
Asthma Patients 5-17
100%
100%
95%
95%
90%
90%
85%
85%
100% 95% 90% 85% 80%
Ages 12-17
xxx
PCQ RC OH
Nat'l Com para tive
94%
97%
95%
80%
Ages 5-17
xxx
PCQR C OH
Nat'l Com parat ive
91%
92%
92%
(National Quality Forum #0041) Ages 6 months & up 100% 80% 60% 40% 20%
6 mos & up
xxx
PCQ RC OH
Nat'l Com para tive
60%
52%
49%
Ages 5-11
xxx
PCQR C OH
Nat'l Com parat ive
90%
93%
91%
NOTES 1- PCQR C OH -Primary Care Quality Reporting Central Ohio Average 2- All data sourced from Electronic Medical Records and was selfreported by medical practices 3- Asthma patient ages are 5-17 4- Influenza Immunization ages 6 months and up 5- Measurement period was 3rd quarter 20122nd quarter 2013
Preventive Influenza Immunizations
0%
80%
5
Attachment A
Participant Terms of Use, Primary Care Quality Prototype Reports ..Central Ohio stakeholders collaborating to improve quality reporting of local patient-centered primary care in 2013 A multi-stakeholder collaborative formed in the fall of 2012. The collaborative will implement a transparent all-patient local prototype of Primary Care Quality Reporting in 2013. Local health care leadership sessions and a project design team have readied this project for Central Ohio. The collaborative intends for this prototype to advance Central Ohio reporting readiness for future primary care quality improvement and demonstration. Participants are those organizations that provide data, view or review reports. Participating Organizations Primary Care Practices
Terms of Use -provide timely, de-identified (no Protected Health Information) data from Electronic Medical Records for the selected measures -respond timely to data inquiry questions -share experiences of participating in local quality reporting -will not use report content to promote or publicize physician practices -use reports to improve quality in your practice
Healthplans, Employers, & Other health care organizations
-share experiences of participating in local quality reporting -will not use report content to promote or publicize physician practices -use reports to work with practices to improve primary care
Access HealthColumbus & its Public-Private Partners
-facilitate the collaborative process in benefiting Central Ohio -maintain project support integrity and timeliness -provide technical services sufficient to support the prototype -manage report sharing with participating organizations
6
Attachment B
Primary Care Quality Reporting – 2013 Prototype EMR Measures Adult Practices NQF# 0059
Quality Measure
Steward
Diabetes: Hemoglobin A1c Poor Control. Description: Percentage of patients 18-75 years of age with diabetes (type 1 or type 2) who had hemoglobin A1c > 9.0 %. Denominator: Patients 18-75 years of age with diabetes with a visit during the measurement period. Numerator: Patients whose most recent HbA1c level (performed during the measurement period) is > 9.0%
NCQA
Rationale: Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body’s inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life‐threatening, life‐ending or life‐altering complications, including poor blood sugar control. Studies have shown that improved glycemic control is correlated with a 40%decline in the development of associated microvascular complications (i.e., eye, kidney and nerve diseases) (ADA 2009). Clinical guidelines recommend regular HbA1c testing to facilitate patients’ ability to improve and sustain acceptable levels (ADA 2009). This measure facilitates the prevention and long‐term management of high blood sugar levels for patients diagnosed with diabetes. 0064
0061
Diabetes: Low Density Lipoprotein (LDL) Management. Description: Percentage of patients 18–75 years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dL) during the measurement period. Denominator: Patients 18-75 years of age with diabetes with a visit during the measurement period. Numerator: Patients whose most recent LDL-C level performed during the measurement period is <100 mg/dL. Rationale: Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body’s inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life‐threatening, life‐ending or life‐altering complications, including poor cholesterol, specifically LDL. Clinical guidelines recommend lifestyle modifications that include reducing intake of saturated fat, trans fat and cholesterol; weight loss; and increased physical activity (ADA 2009). Statin therapy is suggested for eligible patients whose levels are consistently and significantly higher (ADA 2009). This measure facilitates long‐term management of LDL cholesterol levels for patients diagnosed with diabetes. Diabetes: Blood Pressure Management. Description: Percentage of patients 18-75 years of age with diabetes (type 1 or 2) who had a blood pressure < 140/90. Denominator: Patients in the initial population with a diagnosis of diabetes and at least 2 non-acute inpatient or outpatient encounters, or currently receiving medications indicative of diabetes during the measurement period or in the 12 months prior to the measurement period. Numerator: The number of patients whose most recent BP reading during the measurement period was <140/90 mm Hg. Rationale: Diabetes mellitus (diabetes) is a group of diseases characterized by high 7
NCQA
NCQA
0036
0018
blood glucose levels caused by the body’s inability to correctly produce or utilize the hormone insulin It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life‐threatening, life‐ending or life‐altering complications, including poor blood pressure control and subsequent cardiovascular disease of varying severity. Maintaining a healthy blood pressure has been shown to reduce complications due to diabetes, with a 10 mm Hg reduction in systolic blood pressure lowering the risk of complications by 12% It also reduces the chance of cardiovascular disease among patient with diabetes by up to 50% and reduces the chance of other related complications (eye, kidney, nerve) by more than 25% This measure facilitates long‐term management of blood pressure levels for patients diagnosed with diabetes. Use of Appropriate Medications for Asthma. Description: Percentage of patients 550 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period. Denominator: Patients 5-50 years of age with persistent asthma and a visit during the measurement period. Numerator: Patients who were dispensed (or ordered or active) at least one prescription for a preferred therapy during the measurement period. Three age stratifications to report, 5-11 years, 12-50 years, and total. Rationale: This measure assesses the appropriate and timely use of medications for long‐term control of asthma symptoms and offers meaningful and actionable information to health care providers and consumers. Asthma is the most common chronic childhood disease, affecting an estimated 6.2 million children and resulting in more than 6.5 million office visits, 500,000 hospitalizations, 1.51 million nonemergency outpatient department visits and 1.81 million ER visits for children and adults. In 1998, over $10 billion was spent on related medical expenditures in the United States. The financial and disease burden can be alleviated if patients have appropriate medications and medical management. This measure facilitates efforts toward effective disease management and prevention of traumatic outcomes. Controlling High Blood Pressure. Description: Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90 mmHg) during the measurement period. Denominator: Patients 18-85 years of age who had a diagnosis of essential hypertension within the first six months of the measurement period or any time prior to the measurement period. Numerator: Patients whose blood pressure is adequately controlled ( systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mm Hg) during the measurement period. Rationale: This measure assesses the percentage of patients demonstrating adequate control of systolic and diastolic blood pressure levels. Over 50 million Americans warrant treatment for high blood pressure, according to the NHANES survey (JNC‐7 2003). Financially, hypertension and associated disorders and heath complications, such as coronary heart disease and congestive heart failure, cost the U.S. economy more than $100 billion each year. The United States Preventive Services Task Force (USPSTF) recommends that clinicians screen adults 18 and older for high blood pressure (2007). This guideline is further endorsed by research studies and clinical trials that have demonstrated decline in costly health outcomes as a direct result of improved blood pressure control. This measure is important in efforts to promote blood pressure control and improve quality of life.
8
NCQA
NCQA
Attachment C
Primary Care Quality Reporting â&#x20AC;&#x201C; 2013 Prototype EMR Measures Pediatric Practices NQF# 0036
0041
Quality Measure Use of Appropriate Medications for Asthma. Description: Percentage of patients 5-50 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period. Denominator: Patients 5-50 years of age with persistent asthma and a visit during the measurement period. Numerator: Patients who were dispensed (or ordered or active) at least one prescription for a preferred therapy during the measurement period. Three age stratifications to report, 5-11 years, 12-50 years, and total. Rationale: This measure assesses the appropriate and timely use of medications for longâ&#x20AC;?term control of asthma symptoms and offers meaningful and actionable information to health care providers and consumers. Asthma is the most common chronic childhood disease, affecting an estimated 6.2 million children and resulting in more than 6.5 million office visits, 500,000 hospitalizations, 1.51 million nonemergency outpatient department visits and 1.81 million ER visits for children and adults. In 1998, over $10 billion was spent on related medical expenditures in the United States. The financial and disease burden can be alleviated if patients have appropriate medications and medical management. This measure facilitates efforts toward effective disease management and prevention of traumatic outcomes. Preventive Care and Screening: Influenza Immunization. Description: Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization. Denominator: All patients 6 months and older and seen for a visit between October 1 and March 31. Numerator: Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization. Rationale: Annual influenza vaccination is the most effective method for preventing influenza virus infection and its complications. Influenza vaccine is recommended for all persons aged >=6 months who do not have contraindications to vaccination.
9
Steward NCQA
AMAPCPI
SAMPLE B Primary Care Quality Report – Version 1.0 (FICTICIOUS DATA)
Adult Practices Measure, Diabetes Patients, Cholesterol Control Low Density Lipoprotein (LDL) Management
Primary Care Quality Reporting Project Overview – Primary care is front and center in an effort to improve the value of health care in our country. Many communities have advanced with transparent primary care quality reporting. A local multi-stakeholder collaborative formed in the fall of 2012 to implement this transparent all-patient local prototype of Primary Care Quality Reporting in 2013. The collaborative intends for this prototype to advance Central Ohio reporting readiness for future primary care quality improvement and demonstration. This project contributes to aims for better health, care, and value supporting continuous improvement driven by data, including: Coordination of care across the medical neighborhood Optimal use of health information technology Planned care for chronic conditions & preventative care This report is the first of quarterly reports through 2014. Collaborative participants are invited to view this report under the Participant Terms of Use (see Attachment A). Participants are those organizations that provide data, view or review reports. The displayed practice sites have voluntarily participated in sharing their data with the collaborative. Adult Practices Measure, Diabetes Patients, Cholesterol Control Low Density Lipoprotein (LDL) Management (National Quality Forum Measure #0064) Description Percentage of patients 18-75 years of age with diabetes (type 1 or type 2) whose LDL-C was adequately controlled (<100 mg/dL) during the measurement period. The measurement period was 3rd quarter 2012 through 2nd quarter 2013. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body’s inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life‐threatening, life‐ending or life‐altering complications, including poor cholesterol, specifically LDL. Clinical guidelines recommend lifestyle modifications that include reducing intake of saturated fat, trans fat and cholesterol; weight loss; and increased physical activity (ADA 2009). Statin therapy is suggested for eligible patients whose levels are consistently and significantly higher (ADA 2009). This measure facilitates long‐term management of LDL cholesterol levels for patients diagnosed with diabetes. 10
Primary Care Quality Report â&#x20AC;&#x201C; Version 1.0 Adult Practices Measure, Diabetes Patients, Cholesterol Control Low Density Lipoprotein (LDL) Management Practices with predominantly commercial payers. Sort order is practice name. %tiles are derived from all practices. Measurement period: 7/2012-6/2013 LDL<100 m3
49%
m2 m1
45% 36%
l3
73%
l2
56%
l1
54%
k3
k2
71%
32%
k1
59%
j3
43%
j2
72%
j1
48%
i3
76%
i2
51%
i1
38%
h3
72%
h2 h1
70% 32%
g3
66%
g2
42%
g1
66%
f3
58%
f2
f1
74%
35%
e3
68%
e2
e1 d3
65% 37% 35%
d2
38%
d1
69%
c3
67%
c2
47%
c1
71%
b3
76%
b2 b1 a3 a2 a1
50% 33%
57% 62% 61%
11
practice
LDL<100
%tile (tens)
quartile
m3
49%
40%
2nd
m2
45%
40%
2nd
m1
36%
20%
1st
l3
73%
90%
4th
l2
56%
50%
2nd
l1
54%
50%
2nd
k3
71%
90%
4th
k2
32%
10%
1st
k1
59%
50%
2nd
j3
43%
30%
2nd
j2
72%
90%
4th
j1
48%
40%
2nd
i3
76%
100%
4th
i2
51%
40%
2nd
i1
38%
30%
1st
h3
72%
90%
4th
h2
70%
80%
4th
h1
32%
10%
1st
g3
66%
80%
3rd
g2
42%
30%
2nd
g1
66%
70%
3rd
f3
58%
60%
3rd
f2
74%
100%
4th
f1
35%
20%
1st
e3
68%
80%
3rd
e2
65%
70%
3rd
e1
37%
20%
1st
d3
35%
20%
1st
d2
38%
20%
1st
d1
69%
80%
4th
c3
67%
80%
3rd
c2
47%
40%
2nd
c1
71%
90%
4th
b3
76%
100%
4th
b2
50%
40%
2nd
b1
33%
10%
1st
a3
57%
60%
3rd
a2
62%
70%
3rd
a1
61%
60%
3rd
Average National
55% 49%
Primary Care Quality Report â&#x20AC;&#x201C; Version 1.0 Adult Practices Measure, Diabetes Patients, Cholesterol Control Low Density Lipoprotein (LDL) Management Practices with commercial+Medicare as predominant payers. Sort order is practice name. %tiles are derived from all practices. Measurement period: 7/2012-6/2013 LDL<100 v1
u2
LDL<100
%tile (tens)
quartile 4th
75% 39%
u1 t2
practice
64%
v1
75%
100%
u2
39%
30%
1st
u1
64%
70%
3rd
t2
36%
20%
1st
t1
61%
70%
3rd
s2
55%
50%
2nd
s1
44%
40%
2nd
r2
60%
70%
3rd
r1
63%
60%
3rd
q2
53%
50%
2nd
q1
60%
60%
3rd
36%
t1
61%
s2
55%
s1
44%
r2
60%
r1
63%
q2
53%
q1
60%
p2
62%
p2
62%
60%
3rd
p1
63%
p1
63%
70%
3rd
o2
59%
60%
3rd
o1
72%
90%
4th
n2
74%
100%
4th
n1 Average National
75% 55% 49%
100%
4th
o2
59%
o1
72%
n2
74%
n1
75%
Practices with Self Pay+Medicaid as predominant payers. Sort order is practice name. %tiles are derived from all practices. Measurement period: 7/2012-6/2013
LDL<100 y1
34%
xxx
70%
x2 x1 w2 w1 v2
57%
34% 33% 39% 41%
12
practice
LDL<100
%tile (tens)
quartile
y1
34%
10%
1st
xxx
70%
80%
4th
x2
57%
50%
2nd
x1
34%
10%
1st
w2
33%
10%
1st
w1
39%
30%
1st
v2 Average National
41% 55% 49%
30%
2nd
Attachment A
Participant Terms of Use, Primary Care Quality Prototype Reports ..Central Ohio stakeholders collaborating to improve quality reporting of local patient-centered primary care in 2013 A multi-stakeholder collaborative formed in the fall of 2012. The collaborative will implement a transparent all-patient local prototype of Primary Care Quality Reporting in 2013. Local health care leadership sessions and a project design team have readied this project for Central Ohio. The collaborative intends for this prototype to advance Central Ohio reporting readiness for future primary care quality improvement and demonstration. Participants are those organizations that provide data, view or review reports. Participating Organizations Primary Care Practices
Terms of Use -provide timely, de-identified (no Protected Health Information) data from Electronic Medical Records for the selected measures -respond timely to data inquiry questions -share experiences of participating in local quality reporting -will not use report content to promote or publicize physician practices -use reports to improve quality in your practice
Healthplans, Employers, & Other health care organizations
-share experiences of participating in local quality reporting -will not use report content to promote or publicize physician practices -use reports to work with practices to improve primary care
Access HealthColumbus & its Public-Private Partners
-facilitate the collaborative process in benefiting Central Ohio -maintain project support integrity and timeliness -provide technical services sufficient to support the prototype -manage report sharing with participating organizations
13