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The Opportunity
Patients with multiple chronic conditions (MCCs) represent a growing segment of the population, and currently include over one quarter of the U.S. population.1, 2 Despite the growing prevalence of individuals with MCCs, these patients are largely not addressed by available quality measures.
Uses of condition-specific performance measures for pay-for-performance programs, public reporting, or quality improvement may result in poor quality care and even harm to patients with MCCs, as well as provide misleading feedback for their physicians.3 Therefore, NQF-endorsed measures that cross clinical care settings and are meaningful to patients are particularly germane to this population.
Under the guidance of a multi-stakeholder steering committee, NQF will develop a patient-centric measurement framework for individuals with MCCs. Specifically the framework will:
- Establish definitions, domains and guiding principles that are instrumental for measuring and reporting the efficiency of care for patients with MCCs
- Adapt the NQF-endorsed Patient-focused Episodes of Care Measurement Framework for patients with MCCs who have overlapping episodes of care; addressing the population at risk, the interplay among multiple evaluation and initial management stages and the unique nature of follow-up care.
- Build upon the National Quality Strategy, HHS’s Multiple Chronic Conditions Framework and the work of other private sector initiatives such as the National Priorities Partnership.
- Support the development and application of measures by identifying measure gaps, guiding endorsement decisions, guiding selection of measures for public reporting and payment programs and informing research.
About the Project
This project began in April 2011.
Objectives
NQF seeks to develop and endorse a Measurement Framework for Multiple Chronic Conditions as a foundation for the future endorsement of performance measures that explicitly address MCCs.
NQF Process
Measures will be considered for NQF endorsement as national voluntary consensus standards based on the recommendations developed through NQF’s formal Consensus Development Process (CDP, Version 1.8). This project involves the active participation of represent from across a broad spectrum of healthcare stakeholders and will be guided by a Steering Committee.
Funding
This project is supported under a contract provided by the Department of Health and Human Services.
Related NQF Work
Contact Information
For further information, contact Aisha Pittman, MPH at 202-783-1300 or via e-mail at MCCs@qualityforum.org.
1 http://www.hhs.gov/ophs/initiatives/mcc/index.html.
2Kenneth E. Thorpe and David H. Howard The Rise In Spending Among Medicare Beneficiaries: The Role Of Chronic Disease Prevalence And Changes In Treatment Intensity Health Affairs, September/October 2006; 25(5): w378-w388.
3Mary E. Tinetti, Sidney T. Bogardus, Jr., and Joseph V. Agostini Potential Pitfalls of Disease-specific Guidelines for Patients with Multiple Conditions NEJM, December 30, 2004; 351;27 2870-2874.
NQF seeks to achieve consensus on a measurement framework for assessing the efficiency of care—defined as quality and costs—provided to individuals with multiple chronic conditions (MCCs) in order to encourage the development and application of performance measures that address the complex circumstances of this population.
A Call for Nominations for the Steering Committee closed on July 14, 2010. For information on the Steering Committee formation process, please refer to the Call for Nominations document.
Call for Nominations (PDF)
The 14-day review period for submitted nominees closed on October 13, 2010. Members and the public were able to provide feedback on the proposed roster and potential vacancies in expertise.
The Multiple Chronic Conditions Steering Committee met via web meeting on June 9, 2011 to address the following objectives:
- Review project scope and how the project aligns with existing efforts
- Review and discuss key issues, including the definition of multiple chronic conditions
This meeting was open to NQF Members and the public.
The Multiple Chronic Conditions Steering Committee met on July 8, 2011 in Washington, DC. The steering committee reached agreement on a definition of multiple chronic conditions (MCC), refined the key issues to be addressed in the MCC framework, developed an MCC conceptual model, and defined the domains in the MCC framework.
This meeting was open to NQF Members and the public.
The Multiple Chronic Conditions Steering Committee met via web meeting on July 29 to further discuss the key methodological issues associated with measuring the care provided to patients with multiple chronic conditions. This meeting was open to NQF Members and the public.
The Multiple Chronic Conditions Steering Committee met on August 8, 2011 to address the following objectives:
- Finalize definition of multiple chronic conditions (MCC)
- Establish guiding principles for measurement
- Finalize the multiple chronic conditions conceptual model
- Prioritize key measure concepts areas
- Discuss path forward and policy implications of framework
This meeting was open to NQF Members and the public.
The Multiple Chronic Conditions (MCC) Steering Committee met via web meeting on December 2, 2011 to reach agreement on the draft MCC framework report. This meeting was open to NQF Members and the public.
The member voting period closed on March 20, 2012.
NQF hosted a webinar to provide an overview of the MCC Measurement Framework Report. This report highlights definitions, key measurement areas, and guiding principles that are instrumental for measuring and reporting the quality of care for patients with MCCs.
No appeals were filed during this time.
