NATIONAL CONSENSUS STANDARDS FOR PHYSICIAN PERFORMANCE: ROUND 1

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NATIONAL CONSENSUS STANDARDS FOR PHYSICIAN
PERFORMANCE ROUND 1

• Kenneth W. Kizer, M.D., M.P.H.
• President and CEO
• National Quality Forum
• August 22, 2005

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Presentation Overview

• Provide some context for physician performance
  standards
• Provide an overview of the NQF Ambulatory Care PM
  Project
• What has occurred to date?
• What is forthcoming?

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• THE IDEA OF HAVING
• STANDARDS FOR PHYSICIAN
• PERFORMANCE IS NOT NEW

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(No Transcript)
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The Quest for Healthcare Quality

• If a physician make a large incision with the
  operating knife and cure it,, he shall receive
  ten shekels in money.
• If a physician make a large incision with the
  operating knife, and kill him,, his hands shall
  be cut off.
• Code of Hammurabi, 1870 BC

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• TODAYS INCREASED ATTENTION TO HEALTHCARE QUALITY
  IS BEING DRIVEN BY AN UNPRECEDENTED CONFLUENCE OF
  FORCES

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Healthcare Quality Improvement Driving Forces

1. Knowledge of deficiencies
2. Rising healthcare expenditures
3. Purchaser activism
4. Consumerism
5. Regulation and accreditation

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A CROWDED FIELD

• Who are the players in the performance
  measurement and quality improvement game?

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A partial list of the Alphabet Soup of
PM/QI-Related Organizations

• JCAHO NCQA CMS
• IOM AHRQ FDA
• NQF CDC QIOs
• HQA GAO PCPI
• OPM NBCH ACQA
• Leapfrog MedPAC ACMQ IHI
  WBGH PBGH
• QUIC UHC ABMS

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Lots of Signals.. BUT Little Direction
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• There is need for a single national entity to
  be the steward for healthcare performance
  measurement and quality improvement.

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• The
• NATIONAL QUALITY FORUM
• (NQF)

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• NQF-ENDORSED CONSENSUS STANDARDS

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NQF Consensus Development Process
Board of Directors, NQF Staff
Management Member Councils, Non-member External
Entities
Conceptualize and Plan Project
Appoint Steering Committee and Technical Advisory
Panels
NQF ( nominations from membership and public)
Steering Committee with NQF Staff (any entity
can propose measures, etc., for consideration
Identify (open call) and Evaluate measures,
etc. Propose candidate voluntary consensus
standard (VCS)
Review and Revise
Member Councils, Member Organizations, Public
Vote by Member Councils
Member Organizations
Member Councils, Member Organizations, Public
Approved by All Member Councils
Review and Revision of unapproved VCS
Review and Revision of unapproved VCS
Repeat Vote
Approved by 0 or 1 Council (no further action)
Approved by at least 2 Councils
Board of Directors Vote
Board of Directors
Members and Nonmembers directly and materially
affected by VCS
Appeals of Board-endorsed VCS
NQF-Endorsed Voluntary Consensus Standard
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NQF National Consensus StandardsPatient Safety

• Patient Safety Strategic Priorities (2001)
• Serious Reportable Adverse Events (2002)
• Safe Practices (2003)
• Standardized Patient Safety Taxonomy (2005)
• Improved Medication Use Recommendations (2005)
• Improved Informed Consent Process (2005)

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NQF National Consensus Standards
Institutions/Settings of Care

• Acute Care Hospital National Performance Measures
• Initial Set (2003)
• Nursing Care PMs (2004)
• Cardiac Surgery PMs (2004)
• Coordination of Care PMs (2005)
• Mortality for AMI, CHF and CAP (2005)
• HCAPHS (2005)

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NQF National Consensus Standards
Institutions/Settings of Care

• Nursing Home Care Performance Measures (2002,
  2004)
• Home Care PMs (2005)
• Palliative and Hospice Care Framework (2005)
• Ambulatory Care (2004-2008)
• Dialysis Centers/ESRD (2006)

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NQF National Consensus Standards
Conditions/Populations

• Diabetes (2002, 2005)
• Cancer Care Quality Measures (2004-2007)
• Deep Venous Thrombosis (2005-2007)
• Child Healthcare PMs (?2006)
• Behavioral Healthcare PMs (2005-2006)

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NQF National Consensus Projects

• National Priorities for Healthcare Quality
  Measurement and Reporting
• 15 Healthcare conditions priorities
• 5 Process of care priorities
• 2 Infrastructure priorities

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• NATIONAL CONSENSUS STANDARDS FOR AMBULATORY
  CARE

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NQF National Consensus Standards Ambulatory
Care Project

• Phase I (2004) Identify priority areas
• Phase II (2005) Expedited consensus of
  existing ambulatory care PMs
• Phase III (2005-2008) Flesh out all 12 priority
  areas four cycles

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National Consensus Standards for Ambulatory Care
Phase I - Priority Areas

• Patient experience with care
  
• Coordination of care
  
• Asthma
  
• Prevention, including immunization
• Medication management
• Ischemic heart disease
• Diabetes
• Hypertension
• Depression
• Obesity
  

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National Consensus Standards for Ambulatory Care
Additional Priority Areas

• Prenatal care
• Bone conditions

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National Consensus Standards for Ambulatory Care
Phase II

• 36 physician-focused PMs endorsed in seven
  priority areas (8/3/05)
• 6 measures will undergo a second round of voting
• 2 measures not endorsed will be re-considered in
  Phase 3

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NQF-EndorsedTM Ambulatory Care Consensus
Standards

• Asthma/Respiratory Illness (4)
• Behavioral Health/Depression (3)
• Bone Conditions (2)
• Heart DiseaseCAD(10), CHF (7)
• Hypertension (2)
• Prenatal Care (2)
• Prevention, Immunization, and Screening (6)

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NQF-EndorsedTM Ambulatory Care Consensus
Standards

• Asthma/Respiratory Illness
• Asthma assessment
• Asthma pharmacologic therapy
• Appropriate treatment for children with upper
  respiratory infection
• Appropriate testing for children with pharyngitis

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NQF-EndorsedTM Ambulatory Care Consensus
Standards

• Behavioral Health/Depression
• Optimal practitioner contacts for medication
  management
• Effective acute phase treatment
• Effective continuation phase treatment
• Bone Conditions
• Osteoarthritis assessment for use of
  anti-inflammatory or analgesic over-the-counter
  medications
• Osteoarthritis functional and pain assessment

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NQF-EndorsedTM Ambulatory Care Consensus
Standards

• Heart DiseaseCoronary artery disease
• Symptoms and activity
• Cholesterol screen
• Lipid profile
• Drug therapy for lowering low-density lipoprotein
  (LDL) cholesterol
• Cholesterol control
• LDL cholesterol level
• Anti-platelet therapy
• Beta blocker therapyprior myocardial infarction
• ACEI/ARB therapy
• Smoking cessation and smoking cessation
  intervention      

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NQF-EndorsedTM Ambulatory Care Consensus
Standards

• Heart DiseaseCongestive heart failure
• Left ventricular function (LVF) assessment
• Weight measurement
• Assessment of clinical symptoms of volume
  overload
• Assessment of activity level
• Beta blocker therapy
• ACEI/ARB therapy
• Warfarin therapy for patients with atrial
  fibrillation

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NQF-EndorsedTM Ambulatory Care Consensus
Standards

• Hypertension
• Plan of care
• Controlling high blood pressure
• Prenatal Care
• Anti D immune globulin
• Screening for human immunodeficiency virus (HIV)

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NQF-EndorsedTM Ambulatory Care Consensus
Standards

• Prevention, Immunization, and Screening
• Tobacco use and tobacco cessation
• Advising smokers to quit, discussing smoking
  cessation medication, and discussing smoking
  cessation strategies
• Discussing urinary incontinence and receiving
  urinary incontinence treatment
• Flu shot for older adults and flu shot for adults
  ages 50-64 years
• Influenza vaccination
• Pneumonia vaccination
•    

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Phase II Measures in 2nd Round of Voting

• Use of appropriate medications for people with
  asthma
• Coronary artery disease Beta-blocker treatment
  after a heart attack
• Childhood immunization
• Breast cancer screening
• Colorectal cancer screening
• Cervical cancer screening

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National Consensus Standards for Ambulatory Care
Phase III

• Cycle 1 (Fall 2005) care coordination,
  medication management, obesity, asthma,
  hypertension, prevention
• Cycle 2 (Spring 2006) patient experience with
  care, heart disease, bone conditions, prenatal
  care, behavioral health, diabetes

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National Consensus Standards for Ambulatory Care
Phase III

• Cycle 3 (2006-2007) special ambulatory settings
  of care (i.e., ambulatory surgical centers)
• Cycle 4 (2007-2008) development of
  index/composite measures

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National Consensus Standards for Ambulatory Care
Project Deliverables

• Sets of endorsed consensus standards
• Recommendations for implementation and research
  issues for each set.
• Commissioned background paper on barriers to
  small group (lt 5), provider-level implementation
• Index(es)/composite(s) for ambulatory care
  measurement and reporting.
• Workshop to guide ambulatory care measurement
  research, development, and testing