NQF and PQA: Shaping Medication Management Quality

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• NQF and PQA Shaping Medication Management
  Quality
• Terri Smith Moore, PhD, MBA, RPh
• National Quality Forum
• Senior Program Director
• May 1, 2007

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Presentation Overview

• Background and context for NQF safety and quality
  work
• NQFs work to date
• NQFs Therapeutic Drug Management Quality project
• NQF and PQA

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Healthcare Quality Improvement Five Key Driving
Forces

• Knowledge of deficiencies
• Rising healthcare expenditures
• Purchaser activism
• Consumerism
• Regulation and accreditation

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The Quality Confusion

• Lack of a coordinated process for selecting
  standardized measures across the spectrum of
  healthcare entities
• Lack of national goals to focus efforts
• Hundreds of quality initiativeseverybody has a
  better plan

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Concern About Multiple Initiatives
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• There is great need for a single national
  entity to be the lead steward for healthcare
  quality improvement.

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NQF History

• Presidential Advisory Commission on Consumer
  Protection and Quality in the Health Care
  Industry established (1996)
• Commission recommended the creation of a private
  sector entity (Quality Forum) that would bring
  healthcare stakeholders together to standardize
  health care performance measures and standards
  (1998)
• Quality Forum Planning Committee convened by
  White House (1998)
• NQF incorporated in District of Columbia (1999)
  operational (2000)
• Merger of NQF with the National Committee for
  Quality Healthcare (2006)

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NQF Mission

• To improve the quality of American healthcare
  by
• setting national priorities and goals for
  performance improvement,
• endorsing national consensus standards for
  measuring and publicly reporting on performance,
  and
• promoting the attainment of national goals
  through education and outreach programs

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NQF .

• Is a voluntary consensus standards-setting
  organization
• Facilitates consensus on standards (frameworks,
  measures, practices, etc) among stakeholders
  using a unique Consensus Development Process
  (CDP) with special standing under Federal law

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NQF Structure

• Board of Directors
• Leadership from CMS, AHRQ, DOD
• Private sector representatives (e.g., GM, AARP)
• Joint Commission, NCQA, IOM, NIH, and AMA PCPI
• State health officer and Medicaid representatives
• NQF Funding
• Primarily project-specific
• Some membership dues
• Currently exploring core funding opportunities

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Consensus Process

• Nomination and appointment of Steering Committee
  (SC) and Technical Advisory Panel(s) (TAP)
• Open call for Measures, Practices, Frameworks
  (i.e., standards)
• TAPs make recommendations to SC after technical
  review
• SC makes recommendations to NQF Membership
• Drafting and dissemination of recommended
  consensus standards to Members and public

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NQF Accomplishments in 7 Years

• As neutral convener, NQF has brought together
  healthcare stakeholders to discuss a wide range
  of issues
• Endorsed over 200 performance measurement
• standards, including
• 30 Safe Practices
• 27 Serious and Reportable Events
• Several Frameworks and Preferred Practices for
  Quality

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Selected Projects

• HCAHPS (2005)
• Serious Reportable Adverse Events (2002, updated
  2006)
• Ambulatory/Physician Care (2004-2008)
• Safe Practices (2003, updated 2006)
• Adult Diabetes Care Consensus Standards (2003,
• updated 2006)

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More projects

• Hospital Care-
• National Framework (2002)
• Hospital Consensus Standards (2003, updated 2006)
• Cardiac Surgery Consensus Standards (2004)
• Nursing Care Consensus Standards (2004)
• Nursing Home Care Consensus Standards (2004)

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--and more projects

• Home Health Care Consensus Standards (2005)
• Child Healthcare Quality Measurement and
  Reporting Workshop (2004)
• National Framework for Palliative and Hospice
  Care Quality Measurement (2006)
• Healthcare-associated infections (2006-2007)
• Substance Use Disorders Practices (2006-2007)
• Therapeutic Drug Management Quality Project
  (2006-2007)

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The Quest for Healthcare Quality One example

• It would be a good thing for the world at
  large, however unprofessional it might be, if
  medical men were required by law to write out in
  full the ingredients named in their
  prescriptions. Let them adhere to the Latin, or
  Fejee if they choose, but discard abbreviations,
  and form their letters as if they had been to
  school one day in their lives, so as to avoid the
  possibility of mistakes on that account.
• Mark
  Twain
• San
  Francisco Morning Call
• 
  October 1, 1864

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TDM Quality Project

• Therapeutic Drug Management (TDM) project
• launched in June 2006.
• Project Goals
• Achieve consensus on comprehensive framework for
  TDM
• Identify and endorse performance standards/
  measures
• Identify preferred practices for TDM

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TDM Project Activities

• Commissioned a framework paper (Nov 2006)
• Convened a workshop Building A Framework for
  Measuring Therapeutic Drug Management Quality
  (Dec 2006)
• Evaluation of framework and available measures
  and practices, guided by a Steering Committee,
  assisted by Technical Advisory Panels (2007)

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TDM Framework Domains

• The TDM framework addresses the following
  domains
• Therapeutic decision making/ effective
  evidence-based medication therapy
• Education and adherence / patient behaviors
• Safety/ safe medication use/ error avoidance
• Efficiency / cost-effectiveness
• Implementation/ system coordination and
  communications

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Measure Evaluations

• Conducted on candidates that meet purpose, scope,
  prioritization, and selection criteria
• Each candidate assessed against criteria
• Rationale
• Importance
• Specifications
• Scientific acceptability
• Usability
• Feasibility
• Comparison to like measures

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NQF and PQA

• ..this is where NQF and PQA come together

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NQF and PQA

• Similar goals to improve health care quality
• PQA development of measures related to
  performance at the pharmacy and pharmacists
  levels
• NQF assess relative value of measures (i.e.,
  endorsement)

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TDM Project and PQA

• TDM project and PQA both interested in
• Medication adherence/persistence
• Medication appropriateness
• Safe use of medications
• Medication utilization
• Efficiency (e.g., generic drugs)
• Documentation/reporting
• Implementation

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NQF and PQA

• NQF is available to respond to PQA questions and
  provide appropriate suggestions
• Both address similar measurement issues
• Overlap in project participants

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• The work being done in quality

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..aims to bridge the gap

• Current
  Optimal

GAP
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and the work isnt easy

• Huff! Puff!

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but its important!
And well all share in the success!
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• Questions or Comments?
• tmoore_at_qualityforum.org
• www.qualityforum.org