National Voluntary Consensus Standards for Hospital Care 2007: Additional Performance Measures
Access the Final Report: National Consensus Standards for Hospital Care: Specialty Clinician Measures
The Opportunity
The starting point for this 2007 effort was the existing NQF-endorsedTM hospital performance measures and NQF’s 2003 report A Comprehensive Framework for Hospital Care Performance Evaluation: A Consensus Report. Each content area identified in the comprehensive framework report addressed one or more of the IOM aims. To date, the National Quality Forum has endorsed 69 voluntary consensus standards for measuring the performance of acute care hospitals.
Despite this growing list of endorsed measures, many critical aspects of hospital care are not addressed. In selecting these additional 44 performance measures, priority was given to the following areas:
- adult and pediatric populations;
- anesthesia and surgery (including surgical volume and mortality);
- volume and mortality (medical and surgical);
- utilization/readmission rates for high risk (or often unnecessary) procedures;
- readmission rates and length of stay (medical and surgical); and
- patient safety.
About the Project
The principles for hospital care performance measurement used in this project were derived from the NQF-endorsed conceptual framework delineated in A Comprehensive Framework for Hospital Care Performance Evaluation. The framework calls for measures that are important, scientifically acceptable, useable, and feasible, and it emphasizes the need for completeness and parsimony when updating the measure set. The principles address promoting standardization, driving measure set improvement, and supporting implementation. Additionally, principles that support evidence-based practice and evidence that candidate consensus standards are reliable and valid were adopted and used throughout the process of measure evaluation. These additional 44 measures were published in 2007.
Results
The 44 voluntary consensus standards presented in this report supplement the set of previously endorsed hospital care measures. These measures focus on the areas of patient safety and morbidity and mortality in adult and pediatric populations; anesthesia and surgery (including surgical volume and mortality); utilization rates for high-risk or often unnecessary procedures; and rates for readmission and length of stay.
Process
The 44 endorsed measures included in this report were selected from potential candidate consensus standards that were identified through two NQF open “Call for Measures”, a literature review, consultation with the project Steering Committee and Technical Advisory Panels, and a review of previously endorsed voluntary consensus standards for hospital care performance, including those identified below. Agreement around the endorsed measures was developed through NQF’s formal Consensus Development Process (CDP).
Funding
Support for this project has been provided largely by the Agency for Healthcare Research and Quality (AHRQ) with additional funds provided by the Alliance for Pediatric Quality, America’s Health Insurance Plans, and Blue Cross Blue Shield Association.
For additional information please call 202-783-1300 or e-mail info@qualityforum.org
This NQF project evaluated and endorsed additional performance measures to include a broader array of services and care contexts, with particular emphasis on morbidity and mortality measures, anesthesia and surgery related events measures, measures of utilization rates for risky or often unnecessary procedures, surgical volume and mortality measures, readmission rates and LOS, pain assessment, and pediatric asthma. These additional areas of focus have expanded the usefulness of NQF-endorsedTM hospital performance measures.
The project Steering Committee, representing the full range of stakeholder perspectives, was formed following the process set forth in NQF’s Consensus Development Process. The Steering Committee and TAPs were chosen especially for this project. A Composite Measures Steering Committee was also formed to specifically review and recommend composite measures. Originally this had been formed as a TAP, so the TAP membership was retained when the panel was changed to a steering committee.
Steering Committee and Technical Advisory Panels
Composite Measures Steering Committee
NQF first called for practices in August 2006, then reopened the call specifically for length of stay and hospital readmission measures from February 5 – March 2, 2007.
Table of Submitted Measures
The Steering Committee first convened on February 1, 2007 to review all submissions to date. The TAPs began meeting in February as well, and met as scheduled through the end of the year. For this project, four Technical Advisory Panels – Surgery and Anesthesia, Pediatrics, Patient Safety, and Length of Stay/Readmission – evaluated the candidate measures against the NQF-endorsedTM measure evaluation criteria of importance, scientific soundness, feasibility, and usability and provided recommendations to the Steering Committee. The Steering Committee voted on all measures by January ??, 2008.
NQF staff recommended CSAC endorsement of the 43 measures for public reporting; the five research recommendations, with a slight change to the second recommendation as noted in the discussion, and four of the five additional recommendations based on results of NQF member voting. The standards were sent to the CSAC for review on April 11, 2008. They voted on April 24 to approve 42 measures, and defer approval of the last measure plus a recommendation until the Stroke Steering Committee could review them.
After the CSAC makes its final recommendations, the NQF Board has seven days to make its endorsement decision. The Board endorsed all 42 measures recommended by the CSAC.
The public had 30 days to appeal the decision to endorse a voluntary consensus standard. No appeals were filed.
