Ambulatory Care Overview 

Background

The National Quality Forum's (NQF's) 'Standardizing Ambulatory Care Performance Measures' project is a multiyear, multistage endeavor that seeks consensus on standardized measures for public reporting and accountability of outpatient care performance. The work comprises three phases:

Phase I (2004)

In May 2004, NQF convened a Phase I  workshop of its Members to identify priority areas for ambulatory care quality measurement and reporting. 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.

Access the workshop summary:

Phase II (2005)

To address an urgent need for physician-focused ambulatory care consensus standards, the NQF Board of Directors approved a request from the Centers for Medicare and Medicaid Services (CMS) for expedited review 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. The review became Phase II  of the project. This initial set of ambulatory care consensus standards endorsed 42 measures in seven priority areas: asthma/respiratory illness, bone conditions, heart disease, hypertension, depression/behavioral health, prenatal care and prevention including immunization and screening.

Access the final report: National Voluntary Consensus Standards for Ambulatory Care: An Initial Physician-Focused Performance Measure Set.

Phase III (2006-2008)

Phase III involved seeking consensus on a broad set of performance measures for ambulatory
care in many priority areas. Phase 3 proceeded in the following three cycles:

Cycle 1  - On May 17, 2006, 37 measures were endorsed in five priority areas: asthma/respiratory illness; hypertension; medication management; obesity; and prevention, immunization, and screening;. These measures include 19 measures previously endorsed in Phase II. There were no measures identified for endorsement for care coordination, however, a definition and framework for measuring care coordination was endorsed. Access the final report: National Voluntary Consensus Standards for Ambulatory Care–Part 1.

Cycle 2  - On December 6, 2006, 49 measures were endorsed in the following five priority areas: behavioral health measures including depression, schizophrenia, bipolar disorders and substance use disorders; heart disease measures including coronary artery disease, heart failure; diabetes measures including children; bone/joint conditions including osteoarthritis and osteoporosis; and  prenatal care measures. The Cycle 2 report further builds upon NQF’s earlier work in the ambulatory arena by addressing other
aspects of care, including patient experience with care and special settings of care. It also includes measures to address healthcare disparities and recommendations for measure implementation. Access the final report: National Voluntary Consensus Standards for Ambulatory Care–Part 2.

Cycle 3  - On May 9, 2007, an additional 20 national voluntary consensus standards for ambulatory care were endorsed. The standards addressed care in
the following areas: bone and joint conditions (osteoporosis), eye care, geriatrics, and emergency care. Priority areas: special settings of care (ambulatory surgical centers); patient experience with care; and disparities and development of composite measures. Additionally, the Centers for Medicare and Medicaid Services (CMS) have requested NQF to consider clinician-level measures for eye care; dermatologic conditions, including cancer; osteoporosis; gastrointestinal conditions, including GERD; geriatric conditions, including falls, incontinence, and coordination of care; and emergency care, including both patients discharged by the emergency department and patients admitted to the hospital from the emergency department. This project, National Voluntary Consensus Standards for Ambulatory Care: Specialty Clinician Performance Measures, will be carried out in conjunction with Phase 3, Cycle 3 of the ambulatory care project. Access the final report: National Voluntary Consensus Standards for Ambulatory Care: Specialty Clinician Performance Measures.

Funding

Funding for this project has been provided primarily by the Centers for Medicare & Medicaid Services and the Robert Wood Johnson Foundation.

Related Work

•  Adult Diabetes Care 2005
  
• Ambulatory Care, Additional Clinical Measures (2008)
• Ambulatory Care Eye Care and Melanoma Measures
• Ambulatory Care Measures Using Clinically Enriched Administrative Data
  

For more information, contact Reva Winkler, MD, MPH, at 202.783.1300 or e-mail info@qualityforum.org.