Measurement Framework: Evaluating Efficiency Across Patient-Focused Episodes of Care
Final Report: Measurement Framework: Evaluating Efficiency across Patient-Focused Episodes of Care
The Opportunity
Most Americans will not be able to afford healthcare if expenditures for healthcare services continue to grow at their current pace. Despite per capita spending on healthcare that is more than double that of other industrialized nations, the United States ranks poorly compared with other countries on key indicators of the quality of medical care and the health status of the population. The solution lies in performance measurement, which is widely accepted as essential for upgrading healthcare—by identifying opportunities for improvement, motivating providers to improve, and providing the basis for aligning incentives with better performance. This project was designed to lay the groundwork for a measurement framework that evaluates efficiency, and ultimately value, across patient-focused episodes of care.
The Steering Committee convened by NQF to guide this work determined that an episode of care perspective would be the best approach for determining if the delivery system is indeed achieving its intended purpose, because this approach allows for care to be analyzed over time and offers a useful assessment of the patient’s resultant health status. The framework was further conceptualized for two conditions – acute myocardial infarction (AMI) and low back pain. Further work to date has been completed on breast and colorectal cancers and diabetes and is underway for substance use illness. (An episode of care is a series of healthcare services related to the treatment of a given incidence of illness or provided in response to a patient’s [or other entity’s] request).1
See the Project Brief for more details.
About the Project
This project was completed in March 2009.
Results
This project resulted in a proposed measurement framework for evaluating efficiency and ultimately value across patient-focused episodes of care. This framework is intended to provide guidance to help policymakers, healthcare leaders, and other key stakeholder groups move toward a high-performing healthcare system that is patient-centered, focused on quality, mindful of costs, and vigilant against waste. It also serves as a tool to help identify critical gaps in the quality measurement and as a springboard for defining longitudinal performance metrics that include patient-level outcomes (e.g., health-related quality of life, patient experience with care), resource use (e.g., quantity of services provided to patients, true costs paid for each service), and key processes of care (e.g., shared decision making, patient engagement).
Strategic Direction
In addition to the framework, the National Quality Forum (NQF) created a road map for healthcare quality improvement by convening the National Priorities Partnership (NPP), a collaborative effort of 32 major national organizations (Partners) that collectively influence every part of the healthcare system. The Partners have identified a set of National Priorities and Goals for national action that aggressively targets eliminating harm, eradicating disparities, reducing disease burden, and removing waste from the healthcare system. The Partners also have agreed to work collaboratively and with policymakers, healthcare leaders, and other stakeholders to develop action plans around the Priorities and to align the drivers of change (e.g., payment reform, performance measurement, and accreditation and certification) around common goals.
Process
A multi-stakeholder Steering Committee developed this measurement framework. NQF also convened a workshop to solicit feedback and guidance from a broad group of content experts, including additional input from a Technical Advisory Panel. The draft report was submitted for comment and voting and was endorsed by NQF in March 2009.
Funding
Primary support for this project was provided by the Robert Wood Johnson Foundation. Additional funding was provided by the Commonwealth Fund.
Related Work
Contact Information
For more information, contact Karen Adams, Ph.D. at 202-783-1300 or e-mail info@qualityforum.org.
Notes:
1 Hornbrook MC, Hurtado AV, Johnson RE, Health care episodes: definition, measurement and use, Med Care Rev, 1985;42(2):163-218.p. 171
This framework is intended to provide guidance to help policymakers, healthcare leaders, and other key stakeholder groups move toward a high-performing healthcare system that is patient-centered, focused on quality, mindful of costs, and vigilant against waste.
NQF issued two calls for nominations as a part of the Episodes of Care project. The project included both a Technical Expert Panel (TAP) and a Steering Committee.
Nominations for the Episodes of Care Measurement Framework Steering Committee closed on September 28, 2006 at 6:00 pm ET.
Steering Committee Roster (PDF)
Nominations for the Episodes of Care Measurement Framework TAP closed on December 5, 2007 at 6:00 pm ET.
TAP Roster (PDF)
Member voting closed on February 10, 2007 at 6:00 pm ET. For more information, please review the draft report.
Draft Report
CSAC met in person to consider endorsement of the Episodes of Care Measurement Framework.
After the CSAC meeting, the NQF Board of Directors was notified of the CSAC's decisions. The Board had seven days from notification to ratify any endorsements.
The public had 30 days to appeal the decision to endorse a voluntary consensus standard. No appeals were filed.
