Quality Measurement in Quality Improvement

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Jeffery Geppert Nicole Brennan Health Care Quality Improvement November 7, 2017

The Role of Quality Measurement in Quality Improvement

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Introduction to Battelle • Columbus, Ohio • World’s largest independent research and development organization, operating at the forefront of scientific discovery. We apply cuttingedge research methods to some of today’s most complex public health and healthcare challenges.

• Healthcare Quality Improvement: Centers for Medicare and Medicaid Services, Substance Abuse and Mental Health Agency, Centers for Disease Control and Prevention 2


Quality Measurement in Quality Improvement Utilizing QM and QI to Advance Care Coordination

• Overview  Systems Thinking and Health Care  The National Quality Strategy and Quality Measures  Quality Measurement (QM) and Quality Improvement (QI)  Quality Improvement in Health Care  Care Coordination and the Common Framework  How we can enhance Care Coordination

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Systems Thinking

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Common Framework

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Connection of Quality Improvement and Quality Measurement

• Quality “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” -National Academy of Medicine

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CMS Quality Strategy • Area of Focus  Leading quality measurement alignment,

prioritization, and implementation and the development of new, innovative measures;  Guiding quality improvement across the nation

and fostering learning networks that generate results.

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Strategic Logic

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Quality Strategy

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Goal #3: Promote Effective Communication and Coordination of Care

• Background  Poor coordination of healthcare can result in

harms to healthcare patients and increase costs.  Many healthcare systems do not foster

coordination of care or understanding of patient preferences.

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Goal #3: Promote Effective Communication and Coordination of Care

• Background  1 in 5 Medicare beneficiaries discharged from the

hospital is readmitted within 30 days.  Medication errors and poor communication

between providers in the inpatient setting and other post-acute care settings are some key drivers for readmissions within 30 days.

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Goal #3: Promote Effective Communication and Coordination of Care

• Objectives  Reduce admissions and readmissions  Enable successful transitions between all

settings of care  Enable effective healthcare system navigation

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Goal #3: Promote Effective Communication and Coordination of Care • Objective • Outcome  Reduce

admissions and readmissions

 Evidence-based best practices

that promote appropriate discharge planning, care transitions, and support for community-based care  All partners in a particular

community work in coordination to optimize care and services 14


Goal #3: Promote Effective Communication and Coordination of Care • Objective • Outcome  Enable

successful transitions between all settings of care

 Person-centered discharge

tools are used across all settings  Improved patient experience

with clinician awareness of recommendations  Reduced duplication of testing

and other adverse outcomes due to lack of coordination 15


Goal #3: Promote Effective Communication and Coordination of Care • Objective • Outcome  Enable effective

healthcare system navigation

 Cross-setting, person-centered

discharge planning tools that include person and family goals and preferences  Payer reimbursement is

expanded beyond traditional patient education to include self-management education programs 16


Goal #3: Promote Effective Communication and Coordination of Care

• Achieving our Objectives by  Encouraging care coordination across the

healthcare continuum  Promoting person-centered approach to

coordination of care  Recognizing impact of having critical pieces of

information communicated across the system

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Quality Measurement • What is a Quality Measure  Quantifies healthcare processes, outcomes,

patient perceptions, and organizational structure and/or systems  Associated with the ability to provide high-quality

health care and/or that relate to one or more quality goals for health care  Supported by evidence

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Quality Measurement • Mechanism is Selection and Choice  A tool for making good decisions

− decisions that make it more likely to experience a good result and less likely to experience an adverse result  Increase likelihood of desired health outcomes

− Poor performing clinicians work to become high performing − Patients select high performing clinicians 19


Goal #3: Promote Effective Communication and Coordination of Care

• Quality Measure  Percentage of patients aged 50 years and older

treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient's on-going care

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Goal #3: Promote Effective Communication and Coordination of Care

• Quality Measure  Adult Major Depressive Disorder (MDD):

Coordination of Care of Patients with Specific Comorbid Conditions  Timely Transmission of Transition Record

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Quality Improvement • Mechanism is Standardization  Systematic Behavior

− If we do the same thing we should get the same result  Aligned Behavior

− The work we do is aligned with evidence and best practices

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Quality Improvement

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Quality Improvement • Quality Improvement tends to be about:  Learning,  Culture change  Capacity building  Often the focus is on features that are unique or

idiosyncratic to each organization and context

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Quality Measurement in Quality Improvement • Mutually Supportive

 Benchmarking of quality measures suggests

“sound practices” that may be implemented in quality improvement.  Example: MDD Coordination of Care of Patients

with Specific Comorbid Conditions

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Quality Measurement in Quality Improvement • Quality Measurement is not Quality Improvement  Not every target of quality improvement is

appropriate for quality measurement  Quality measures must justify the burden of data

collection across the system  Quality measures should help with selection

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Quality Measurement in Quality Improvement • Quality Payment Program

 Established by the Medicare Access and CHIP

Reauthorization Act of 2015 (MACRA), is a quality payment incentive program for physicians and other eligible clinicians, which rewards value and outcomes in one of two ways: − the Merit-based Incentive Payment System (MIPS) − Advanced Alternative Payment Models (APMs).

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Improvement Activities • Quality Payment Program  The Improvement Activities performance category

assesses how much a clinician participates in activities that improve clinical practice.  Examples include ongoing care coordination,

clinician and patient shared decision making, regular implementation of patient safety practices, and expanding practice access.

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Care Coordination • National Quality Forum (NQF)  A multidimensional concept that

encompasses the effective communication between patients and their families, caregivers, and healthcare providers  A longitudinal view of care that considers

the past, while monitoring delivery of care in the present and anticipating the needs of the future. http://www.qualityforum.org/Care_Coordination_Measures.aspx

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Care Coordination • Institute of Medicine (IOM)  Care coordination is identified IOM as a key

strategy that has the potential to improve the effectiveness, safety, and efficiency of the American health care system.  IOM estimates there is a potential savings

of $240 billion resulting from care coordination activities

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Care Coordination • Agency for Healthcare Research and Quality  Well-designed, targeted care coordination

that is delivered to the right people can improve outcomes for everyone: patients, providers, and payers.

https://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html

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Care Coordination • Improvement Activities  Care coordination agreements that

promote improvements in patient tracking across settings.  Care transition standard operational

improvements.  Implementation of documentation

improvements for practice/process improvements 32


Care Coordination • Fostering Care Coordination  Ensure that health information is culturally

and linguistically appropriate and that patient and families understand  Build and apply data systems to facilitate

coordination of care across the health care continuum, as well as to facilitate health and wellness of the individual.

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Care Coordination • Fostering Care Coordination  Encourage use of community health

workers, resource coordinators, individuals trained and/or certified in person-centered care planning to support health care system and community navigation.  Promote education and training for

providers on effective techniques for communicating with patients and families. 34


Summary

• How can quality measurement enhance quality improvement? • What resources are available to enhance care coordination?

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References • https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/qualityinitiativesgeninfo/cms-quality-stra tegy.html

• https://qpp.cms.gov/learn/qpp • https://academic.oup.com/heapol/article/27/suppl_4/iv4/620794 • Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy, 2001. Print.

• Langley, Gerald J. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. San Francisco: Jossey-Bass, 2009. Print.

• Berwick DM, James B, Coye MJ, Connections between quality measurement and improvement, Med Care, 2003;41(1 Suppl):I30-I38.n. New York: Duxbury, 2004

• Califf, Robert M., Eric D. Peterson, Raymond J. Gibbons, Arthur Garson, Ralph G. Brindis, George A. Beller, and Sidney C. Smith. "Integrating Quality into the Cycle of Therapeutic Development." Journal of the American College of Cardiology 40.11 (2002): 1895-901. Web.

• CMS Measures Management System Blueprint (the Blueprint) v 12.0 • National Quality Forum, Intended Use Final Report - Recommendations to Enhance the Consensus Development Process (February 2016) (http://www.qualityforum.org/Intended_Use.aspx)

• Gibbons R and Murphy KJ (1992). Optimal Incentive Contracts in the Presence of Career Concerns: Theory and Evidence. Journal of Political Economy: 100(3).

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Questions?

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