Home > About Us > Leadership > President's Report Archive > October 2005
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No significant changes.
There has been one staff departure and four new arrivals since my last report.
If the applications that are pending Board action are approved, NQF organizational membership will stand at 285.
All Member Councils continue to meet regularly by conference calls.
The Spring Membership meeting was held on May 10, 2005, at the Downtown St. Louis Marriott; feedback from the meeting was very positive. In particular, feedback was highly enthusiastic for the conference on implementation of NQF-endorsedTM measures that was held the day before. NQF has had requests from various parties (e.g., American Hospital Association, Federation of American Hospitals, National Rural Health Association) to convene similar meetings with slightly different foci (e.g., only hospitals or for rural healthcare). However, there currently is no funding attendant to support these requests. The May 9, 2005, meeting was convened at the behest of the Centers for Medicare & Medicaid Services (CMS).
John O. Agwunobi, MD, MBA was announced as the designee for appointment as Assistant Secretary for Health at the Department of Health and Human Services. U.S. Senate confirmation is pending.
Clyde Behney has been appointed to the Institute of Medicine liaison seat by Dr. Harvey Fineberg.
The Robert Wood Johnson Foundation (RWJF) has awarded the NQF a $3 million endowment-like grant. An Investment Committee of Paul H. O'Neill (Chair), Gerald M. Shea (Treasurer), and myself will oversee investment of the grant, pursuant to guidelines provided by RWJF.
The Agency for Healthcare Research and Quality (AHRQ) has awarded NQF $25,000 under a small conference grant for the 2005 Annual Meeting.
The Centers for Disease Control and Prevention (CDC) has awarded NQF an additional $144,000 for year-2 of activities related to the Institute for Quality Laboratory Management.
The original funders of the National Commission for Quality Long-term Care have increased support for the Commission. The additional amount equates to approximately $200,000 in 2005, $600,000 in 2006, and $100,000 in 2007.
CMS has forwarded measures for end-stage renal disease quality of care, in anticipation of funding a consensus development project in this area once it identifies a funding vehicle.
We continue to discuss the scope of a project with AHRQ related to its patient safety indicators. This is likely to be a slightly narrower scope than AHRQ's entire quality indicators set as previously requested and approved by the Board for expedited consensus in October 2004.
As an ancillary activity to the project to develop measures for prevention and treatment of venous thromboembolism (VTE) (previously referred to as the project on deep vein thrombosis), sanofi-aventis has approached NQF about convening a separate invitational conference on the issue. Discussions on the scope and nature of such a conference are ongoing.
The Association for Professionals in Infection Control and Epidemiology has provided $25,000 for an NQF project in infection control; additional discussions with other parties to fund the balance of the project are ongoing.
The field portion of the independent audit, conducted by Gelman, Rosenberg, and Freedman, took place April 4-8, 2005. The draft audit report will be reviewed at the meeting on October 7, 2005.
National Framework and Preferred Practices for Palliative and Hospital Care
The Review Committee has concluded its work and a proposed draft framework and preferred practices is in the final stage of preparation for the review phase of the Consensus Development Process. We anticipate it will be launched just before or immediately after the Annual Meeting.
VTE Performance Measures
The Steering Committee and TAP held their initial meetings, and a second call for measures has been conducted by NQF and JCAHO. The Steering Committee will meet on December 19, 2005, to finalize its recommendations for practices and policies for prevention, treatment, and diagnosis of VTE. JCAHO's measure development work is ongoing and will be considered by the Steering Committee next year.
Cancer Care Quality Measures
The project's Breast Cancer Steering Committee met on June 29, 2005, and considered 26 candidate consensus standards. A draft report is in the final stage of preparation for the review phase of the Consensus Development Process. We anticipate it will be launched just before or immediately after the Annual Meeting.
The Technical Panels (TP) for the colorectal cancer and symptom management/end-of-life care priority areas met on September 14 and September 19, 2005, respectively. Both TPs are finalizing their recommendations to the Steering Committee, which will meet to consider them on December 1-2, 2005, in Washington, DC.
Institute for Quality Laboratory Management
As previously noted, CDC has provided additional funding of approximately $144,000 for the second year of the cooperative agreement. Combined with carry-over funds from year 1, CDC has indicated it will request that NQF convene two workshops on various aspects of laboratory medicine quality.
National Voluntary Consensus Standards for Hospital Care—Additional Priority Areas, 2005
The draft consensus report is out to NQF Members for voting; the ballot deadline is October 3, 2005. The Board will consider the results of the voting at the meeting on October 7, 2005.
Ambulatory Care Quality Measures
All four Member Councils approved 36 consensus standards on the first ballot, and the Board subsequently endorsed these during its conference call on August 3, 2005. Eight measures were not approved on the first ballot, six of which had specifications for "optional exclusions." Although the original recommendation approved by the Board was to consider the eight measures during phase 3 of the project, the measure developer, i.e., the National Committee for Quality Assurance, agreed to adjust the specifications to make the exclusions mandatory for those six measures. The Executive Committee then approved a second round of voting, which concluded on September 21, 2005, and will be considered by the Board at its meeting on October 7, 2005.
Phase 3, Cycle 1 of the project has commenced. Cycle 1 encompasses measures for the following priority areas: asthma, coordination of care, hypertension, medication management, obesity, and prevention. The Steering Committee met on August 15, 2005, to establish guidelines for the Technical Advisory Panels' (TAPs) work and the TAPs are now conducting in-person and/or conference calls to evaluate candidate consensus standards. The Steering Committee will meet on December 14-15, 2005, to consider the TAPs' recommendations and a draft consensus report for Cycle 1 measures will be available in early 2006.
Voluntary Consensus Standards for Adult Diabetes Care: 2005 Update
As approved by the Board on its August 3, 2005, conference call, the quality improvement-only and community measures were forwarded to Members for a second round of voting. The ballot deadline was September 16, 2005; the results will be considered by the Board at the meeting on October 7, 2005.
Patient Safety Taxonomy
The draft report recommending the JCAHO Patient Safety Event Taxonomy (PSETTM) as a consensus standard was approved by all four Councils on the first ballot, and the Board endorsed the PSET on its conference call on August 3, 2005. One appeal was received from the Department of Veterans Affairs and will be considered by the Board at the meeting on October 7, 2005.
Implementation of NQF-Endorsed Voluntary Consenus Standards: National Conference
NQF has endorsed performance measure sets for the hospital, nursing home, and home health care settings, and has underway a major project to endorse consensus standards for ambulatory care. On May 9, 2005, NQF convened, at the behest of the CMS, a conference to identify opportunities and barriers to implementation of these measure sets. A meeting summary is being prepared.
Standardizing a Measure of Patient Experience (HCAHPS)
The Board considered an appeal on its August 3, 2005, conference call. The appeal was denied and the report is ready for final publication, but we have suspended the process pending a CMS notice in the Federal Register regarding whether it is proposing material changes to HCAHPS as a result of additional agency deliberations related to its cost-benefit analysis.
Home Health Performance Measures
The report is at the printers and will be available by the Annual Meeting.
Pay for Performance Programs: Guiding Principles and Design Strategies
The report is in the publishing phase, and we anticipate its availability shortly after the Annual Meeting.
Several Members have indicated strong support for NQF to undertake a consensus project on pay for performance program guiding principles and design strategies. The potential need for this is underscored by the now multiple different sets of guiding principles for pay for performance programs promulgated by various organizations and our awareness of several more in development. We continue to explore funding opportunities for such a project.
Improving Safe Use of Prescription Medications
This project, funded by the California Endowment, identifies a "safe medication use framework" aimed at increasing the effectiveness of prescription medication use by patients, especially those with low health literacy and/or limited English proficiency. The report is at the printers, and we anticipate it will be available by the Annual Meeting.
Evidence-based Practices for Substance Abuse Treatment Workshop
On December 13, 2004, NQF convened a workshop, funded by RWJF, to i) identify a set of evidence-based treatments for substance use disorders that are widely recognized as being important components of effective treatment programs, and ii) recommend a set of program-level descriptors relating to those attributes that indicate that evidence-based substance abuse treatments are being provided by the program to its clients. The workshop summary is at the printers, and we anticipate it will be available by the Annual Meeting.
Informed Consent and Patient Safety
This project, funded by the Commonwealth Fund, explored the implementation of the NQF-endorsed Safe Practice 10 relating to informed consent for low literacy/limited English proficient patients. A workshop to discuss the case studies and site visits, results of interviews of non-adopters, and draft user's guide for implementation was held in September 2004. The proceedings and user's guide were published and disseminated to the Board and NQF Members in early September.
Cardiac Surgery Performance Measures
On August 8, 2005, UnitedHealth Group announced an initiative with the Society of Thoracic Surgeons (STS) and the American College of Cardiology (ACC) that will require hospitals seeking United Health PremiumSM to submit data to the STS database and the ACC registry, which both include information on NQF-endorsed measures. We are contacting UnitedHealth to encourage them to publicly report information on the NQF-endorsed consensus standards.
Behavioral Health
The workshop proceedings have been printed and disseminated to the Board and NQF Members.
Safe Practices for Better Healthcare
The Safe Practices Maintenance Committee has met by conference call, and it will hold an in-person meeting on September 30, 2005, in Washington, DC. NQF Members and the public were invited to submit new practices and/or recommend changes to the existing 30 NQF-endorsed practices (including exclusion of a practice). Results from this Call for Practices will be among the issues discussed by the Committee at its in-person meeting.
Serious Reportable Adverse Events in Healthcare
The "Never Events" Maintenance Committee was appointed and has met by conference call to discuss how to proceed with its work and to review the scope, definitions, and criteria established in the NQF-endorsed report. A call for comments on the original list of events (changes or deletions) and/or proposed new events closed on September 20, 2005. The Committee will consider material received from this solicitation, as well as hear from states that have implemented the list or are considering implementation, at an in-person meeting on October 5, 2005.
As noted in the previous report, recent interest in implementation of the list of 27 events is increasing. Minnesota, Connecticut, and New Jersey have implemented the entire list and specifications by statute or regulation; Illinois has implemented 24 of 27 events and specifications; Texas has implemented at least 2 of 27 events and specifications; Georgia has implemented the event descriptions and categories; and Missouri has legislation pending to implement the list. Indiana and California recently expressed interest in implementing the list. The Department of Defense requires all TRICARE contractors to collect the events, as specified. Finally, the province of Saskatchewan, Canada has implemented the list, with some additions.
State-of-the-art in Performance Review Instruments Workshop
A comprehensive quality/performance review program is a management tool used by healthcare systems to aggregate and quantify the various aspects of hospital care to enable comparisons of performance. These programs may include a variety of domains, such as external review (e.g., JCAHO survey results), patient safety, liability/risk management, satisfaction (customer, patient, employee, provider), financial performance, efficiency, and personnel development. A commissioned paper will review current knowledge about the broad hospital quality/performance reporting tools and be discussed by workshop participants, with an eye toward recommending the domains that these tools should encompass, as well as data categories or elements and reporting formats. Because executing an agreement with HCA has proved elusive, we are proceeding with the project with the funding being provided by the Department of Veterans Affairs.
National Commission for Quality Long-Term Care
The Commission held its first public hearing on July 22, 2005, where it heard from federal and state officials, researchers, providers, and consumer advocates. The hearing was well-received, and the Committee will meet on September 26, 2005, in Executive Session to consider the testimony and to discuss its first report, which is currently targeted for delivery in December 2005-January 2006.
An active outreach effort continues.
The Ad hoc Advisory Committee on Evidence Grading was appointed and met by conference call on September 12, 2005, to review a draft grading and evaluation scheme prepared by NQF; a second call is scheduled for September 28. The status of the Committee's deliberations will be reported to the Board at the meeting on October 7, 2005.
The Ad hoc Advisory Committee on Performance Measure Criteria held a conference call on September 13, 2005, and a second conference call is scheduled for September 27. The status of the Committee's deliberations will be reported to the Board at the meeting on October 7, 2005.
A second Call for Nominations for the Voluntary Consensus Standard Maintenance Committees in the pulmonary and cardiac areas closed on September 26, 2005.
NQF has filed to trademark National Quality Forum, NQF-endorsed, and NQF.