Access the Final Report: National Voluntary Consensus Standards for Ambulatory Care: An Initial Physician-Focused Performance Measure Set
The Opportunity
The ambulatory care setting (outpatient care) is the principal venue for delivering medical care across the continuum from primary care to end-of-life care. Effective, high-quality outpatient care is critical, because it allows for the efficient use of resources and provides patients and their providers with options that are cost-effective and that reduce the need for inpatient hospital stays.
The healthcare industry has begun to focus on measuring and reporting the quality of outpatient services, but there is still more to achieve. Focusing on an effort to evaluate, standardize, and implement quality measurement and reporting methodologies builds on the goals of the Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century.
To improve the quality of ambulatory care NQF – with funding from the Centers for Medicare & Medicaid Services (CMS) and the Robert Wood Johnson Foundation - initiated the multi-year, multi-phase Ambulatory Care Project. NQF began with a Member workshop in 2004, to lay the foundation for subsequent work on performance measures.
Following May of 2004, the NQF Board of Directors approved a request from CMS for expedited review (an expedited process differs from a regular consensus process in that the measures for review are a predetermined set, and “competing” measures are not considered) of a predefined set of “physician-focused” ambulatory care measures from CMS, the National Committee for Quality Assurance, and the American Medical Association’s Physician Consortium for Performance Improvement. This expedited review became Phase II of NQF’s Ambulatory Care project.
About the Project
The results from Phase I and Phase II have directly informed the final endorsed measures of all work conducted in phase III of Ambulatory Care as well as the ongoing Ambulatory Care project work.
Results
The Phase I workgroups identified 10 priority areas for quality improvement in ambulatory care: heart disease, diabetes, hypertension, obesity, asthma, prevention, depression, medication management, patient experience with care, and coordination of care. The details of the meeting and workgroup breakout sessions are detailed in the meeting summary.
In Phase II, NQF endorsed an initial set of 42 performance measures of ambulatory care in 7 priority areas: asthma/respiratory illness, bone conditions, heart disease, hypertension, depression/behavioral health, prenatal care and prevention including immunization and screening.
Process
Phase I
In Phase I, NQF convened a meeting in Boston, MA on April 27, 2004. In preparation for the workshop, NQF commissioned a paper that reviewed the challenges of measurement in small-group settings. Meeting participation was open to all NQF Members. NQF designed the workshop so that its findings could lay the groundwork for a multi-year project on the measurement and reporting of ambulatory care quality.
The 10 areas identified through this process were heart disease, diabetes, hypertension, obesity, asthma, prevention, depression, medication management, patient experience with care, and coordination of care. Participants also briefly discussed the design and objectives of Phase II of the Ambulatory Care project. A summary of the workshop was published in August 2004.
Phase II
In 2004, after NQF’s initial meeting to set priorities for ambulatory care quality improvement, NQF began phase II of the Ambulatory Care project. In Phase II CMS requested an expedited review of specific measures for ambulatory care. After the NQF Board of Directors approved the expedited review, NQF considered a predetermined set of measures for endorsement - specifically the Doctor’s Office Quality measure set used by CMS. As the project developed, additional measures from the National Committee for Quality Assurance and the American Medical Association’s Physician Consortium for Performance Improvement were submitted and evaluated.
Phase II followed NQF’s Consensus Development Process, and was guided by a review committee with the help of technical advisory panels. It involved the active participation of representatives from across the spectrum of healthcare stakeholders and resulted in the endorsement of 42 physician-level measures. Phase II concluded in early 2006.
Funding
Funding for both phases of this project was provided primarily by the Centers for Medicare & Medicaid Services and the Robert Wood Johnson Foundation.
Related NQF Work
Contact Information
Reva Winkler, MD, MPH, at 202.555.4555 or e-mail info@qualityforum.org.
NQF’s multi-year, multi-phase Ambulatory Care project began in April 2004 with a one-day Phase I meeting that established the foundation for this project by identifying and prioritizing key areas for measurement. Phase II began a few months later, when the Centers for Medicare & Medicaid Services urgently requested an expedited review of a predefined set of “physician-focused” ambulatory care measures. Phases I and II have provided the foundation for NQF’s ongoing work in Ambulatory Care.
