Washington, DC (November 4, 2009) – The National Quality Forum (NQF) has endorsed six measures to improve quality of eye and skin care in the ambulatory setting. The endorsed measures address melanoma and eye care, specifically glaucoma, macular degeneration, and cataracts.
Melanoma. The American Cancer Society estimates that about 68,720 new melanomas will be diagnosed in the United States during 2009. Although melanoma accounts for less than five percent of skin cancer cases, it causes a large majority of skin cancer deaths. The first new NQF-endorsed® standard for melanoma focuses on coordination of care and is intended to measure the clinician managing the melanoma, regardless of specialty. This standard aligns with the National Priorities Partnership’s priority of improving care coordination. The second new NQF-endorsed standard for melanoma aligns with the National Priority of reducing overuse, targeting appropriate use of diagnostic imaging studies. The measure developer noted that melanoma care costs $240 million year, and as much as 50 percent is related to routine imaging ordered by a host of providers, including dermatologist and primary care physicians.
Eye care. The new NQF-endorsed standards for cataracts focus on complications and visual acuity following cataract surgery. According to the National Eye Institute and Prevent Blindness America (2002), cataracts affect nearly 20.5 million Americans age 40 and older. Other new NQF-endorsed standards for eye care address counseling for age-related macular degeneration, which is anticipated to affect almost 3 million people in the United States by 2020, and treatment and plan of care for glaucoma, the leading cause of blindness among African-Americans.
NQF’s steering committee on eye care and melanoma measures in the ambulatory setting was co-chaired by Jeffery Kang, senior vice president, clinical programs and policy at CIGNA, and Alice Stollenwerk Petrulis, chief medical officer at KePRO.
NQF is a voluntary consensus standards-setting organization. Any party may request reconsideration of the recommendations, in whole or in part, by notifying NQF in writing via e-mail no later than December 3, 2009 to appeals@qualityforum.org. For an appeal to be considered, the notification e-mail must include information clearly demonstrating that the appellant has interests that are directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests.
The mission of the National Quality Forum is 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. NQF, a non-profit organization (www.qualityforum.org) with diverse stakeholders across the public and private health sectors, was established in 1999 and is based in Washington, DC.
Table of Endorsed Measures
MELANOMA
AED-03-08
Melanoma Coordination of Care - Percentage of patients seen with a new occurrence of melanoma who have a treatment plan documented in the chart that was communicated to the physician(s) providing continuing care within one month of diagnosis.
AED-04-08
Melanoma: Appropriate Use of Imaging Studies - Percentage of patients with stage 0 or IA melanoma, without signs or symptoms, for whom no diagnostic imaging studies were ordered.
EYE CARE
AED-05-08
Primary Open-Angle Glaucoma: Reduction of Intraocular Pressure by 15 percent or Documentation of a Plan of Care - Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15percent from the pre-intervention level) OR if the most recent IOP was not reduced by at least 15 percent from the pre-intervention level a plan of care was documented within 12 months.
AED-07-08
Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures - Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence.
AED-10-08
Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement - Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the AREDS formulation for preventing progression of AMD.
Definition of counseling: Documentation in the medical record should include a discussion of the risks and/or benefits of the AREDS formulation. This can be discussed with all patients with AMD, even those who do not meet the criteria for the AREDS formulation, patients who are smokers (beta-carotene can increase the risk of cancer in these patients), or other reasons why the patient would not meet criteria for AREDS formulation as outlined in the AREDS. The ophthalmologist or optometrist can explain why these supplements are not appropriate for their particular situation. Also, given some of the purported risks associated with antioxidant use, patients should be informed of risks and benefits and make their choice based on valuation of vision loss vs. other risks. As such, the measure seeks to educate about overuse as well as appropriate use.
AED-08-08
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery - Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following the cataract surgery.
