FOR IMMEDIATE RELEASE
Aug. 5, 2008

CONTACT: Stacy Fiedler, NQF
202 783 1300 ext. 179
sfiedler@qualityforum.org

 

NATIONAL QUALITY FORUM ENDORSES
NATIONAL CONSENSUS STANDARDS PROMOTING
ACCOUNTABILITY AND PUBLIC REPORTING

Standards emphasize measurement gaps and harmonization

Washington, DC - To fill gaps in assessing clinician performance that can promote higher quality health care, the National Quality Forum (NQF) has endorsed 67 clinician-level consensus standards relating to cancer care, infectious diseases, perioperative care, and care provided by thousands of medical professionals who are not MDs, but provide critical services. NQF also endorsed four facility-level measures in surgery and anesthesia, 17 measures addressing prevention and management of stroke across the continuum of care, and three measures for influenza and pneumococcal immunizations, a total of 91 consensus standards.

NQF-endorsed™ voluntary consensus standards are widely viewed as the “gold standard” for the measurement of healthcare quality.

“A commitment to public reporting and transparency can make the real difference in improving safety, healthcare quality, and patient engagement,” said NQF president and CEO Dr. Janet Corrigan. “This important set of measures can help us track progress toward improved safety and coordination of care across clinicians and settings.”

NQF has not previously addressed the area of infectious disease, particularly hepatitis and HIV/AIDs. The NQF portfolio already includes facility-level cancer and perioperative care measures, which are expanded and enriched by this new clinician-level measure set.

The purpose of NQF-endorsed voluntary consensus standards is to improve the quality of health care—through accountability and public reporting—by standardizing quality measurement in all care settings.

Cancer Care

Cancer exacts a tremendous toll. In 2008, approximately 1.4 million Americans will be diagnosed with some form of cancer. Half a million will die. The financial burden associated with cancer care was estimated at $219.2 billion for 2007.

The 16 new NQF-endorsed voluntary consensus standards for cancer care can be used to raise the quality of care by evaluating the performance of clinicians working in hematology, radiation oncology, breast cancer, prostate cancer, and pathology pertaining to cancer care at the clinician level. For example, these measures can help decrease unnecessary bone scans for prostate cancer, avoid radiation dosing for normal tissue, and support patient engagement by communicating treatment/pain management plans.

Lee Newcomer, MD, executive vice president of oncology at United HealthCare in Minnesota, and Suzanne Miller, MD, director of behavioral medicine at the Fox Chase Cancer Center in Pennsylvania, co-chaired NQF’s steering committee on clinician-level cancer care. “There’s an overwhelming amount of misinformation about what constitutes good care,” said Miller. “Quality measures, particularly at a clinician level, pave the path for communicating with patients and providing patient-centered care in a comprehensive way.”

Measures were developed by the American Medical Association’s Physician Consortium for Performance Improvement, the American Society for Therapeutic Radiology and Oncology, the American Society of Clinical Oncologists, the American Society of Hematology, the American Urological Association, and the College of American Pathology.

Infectious Diseases

The 23 new NQF-endorsed voluntary consensus standards for infectious disease prevention, treatment, and management fill an urgent need within the current landscape of quality measures. Hepatitis C (HVC)-associated chronic liver disease is the most frequent indication for liver transplantation among adults in the United States. A study of Asian American adults found 10.7 percent of those born in Southeast Asia or the Pacific Islands were chronically infected with Hepatitis B (HVB), and up to two-thirds were unaware they were infected.

With at least 4 million people infected with HVC and an estimated 1.1 million living with HIV/AIDS, these diseases, along with HVB, are major health challenges for the nation. Patients require complex and coordinated care, made more challenging because many have additional complicated conditions.

Cindy Weinbaum, MD, MPH, team leader at the Prevention Research and Evaluation Division of Viral Hepatitis, Centers for Disease Control & Prevention, and Fred Rachman, MD, chief executive officer and chief medical officer at the Alliance of Chicago Community Health Services, co-chaired NQF’s steering committee on clinician-level infectious diseases.  

"Given the known gaps and variations in care for patients infected with HIV/AIDS and Hepatitis B and C, it is imperative that the medical community begin to systematically measure itself at the individual clinician- and system-level to identify where improvement efforts are needed,” said Rachman. “The NQF process is instrumental for endorsing a single set of consensus standards that will help alleviate the multiple, competing sets of measures for HIV/AIDS and hepatitis against which clinicians are currently measured. This supports our ultimate aim – a uniform standard of care that every consumer can expect."

Measures were developed by the American Medical Association’s Physician Consortium for Performance Improvement, the Asian Liver Center at Stanford University, and the National Committee for Quality Assurance.

Perioperative Care

Seventeen new NQF-endorsed voluntary consensus standards include clinician-level and facility-level performance measures for critical care and anesthesiology; perioperative management; and general thoracic surgery. Additionally, prophylactic antibiotic measures previously endorsed by NQF were updated to include foot and ankle procedures.

Darrell Campell, MD, professor of surgery and chief of staff at University of Michigan Hospitals and Health Centers, and Rome Walker, MD, medical director at Anthem Blue Cross Blue Shield in Virginia, co-chaired NQF’s perioperative care steering committee.

“All stakeholders, including employers, physicians and the government, are looking for endorsed standards like these perioperative performance measures that are feasible, reliable, and valid,” said Walker. “NQF is recognized as the principal body in the United States for the endorsement of healthcare performance and quality measures. The newly endorsed perioperative performance measures on a clinical level will be the driving force for improvement in both processes and health outcomes for patients.”

The standards measure the quality, efficiency, and care coordination of surgical care, including pre-operative, intra-operative and post-operative care within the surgical facility, as well as coordination with appropriate external providers. This includes perioperative temperature management for surgery patients and post-operative urinary catheter removal. There was a significant effort to ensure the facility-level standards were harmonized with the clinician-level perioperative standards.

Measures were developed by the Agency for Healthcare Research and Quality, the American Medical Association’s Physician Consortium for Performance Improvement, the Centers for Medicare & Medicaid Services, LifeScan, the National Committee for Quality Assurance, the Society of Thoracic Surgeons, the Society for Vascular Surgery, and the Vascular Study Group of Northern New England.

Nonphysician Professionals

Providing high-level health care requires a multidisciplinary approach. Yet consensus standards endorsed to date have mainly targeted traditional physician practices. Fifteen new NQF-endorsed voluntary consensus standards measure care at a clinician level for non-physician professionals, including podiatrists, clinical social workers, clinical psychologists, dieticians/nutritionists, physical therapists, occupational therapists, and speech-language pathologists.

Anne Deutsch, a clinical research scientist at the Rehabilitation Institute of Chicago, and Carol Wilhoit, MD, quality improvement medical director at Blue Cross Blue Shield of Illinois, co-chaired NQF’s steering committee for clinician-level measures for non-physician professionals.

“NQF endorsement of these measures is important, because patients’ healthcare needs are frequently complex and require treatment from an interdisciplinary team of health care professionals,” said Deutsch. “NQF endorsement of these non-physician measures is an important step forward in performance measurement and public reporting.”

These measures include diabetic foot and ankle care, depression screening and follow-up, current medication verification, pain assessment and follow-up, weight screening and follow-up, and functional status. The measures are evidence-based and have been used to measure quality for many years, but many have not been used as clinician-level performance measures.

“For health plans, NQF-endorsed indicators provide a framework that can be used for measuring performance and then collaborating with providers to improve care,” said Wilhoit. “The new NQF-endorsed measures for non-physician professionals will help expand these activities to a broader group of medical professionals.”

Measures were developed by the American Podiatric Medical Association, Boston University, Centers for Medicare & Medicaid Services, Focus On Therapeutic Outcomes, and Quality Insights of Pennsylvania.

Stroke

More than 700,000 people will have a stroke this year; of these, 200,000 will be recurrent strokes. Seventeen new NQF-endorsed voluntary consensus standards aim to make care more patient -centered, prevent re-occurring strokes, and improve quality across an episode for stroke, including acute care, post-acute follow-up, rehabilitation, and post-rehabilitation. A measure of acute stroke mortality was also endorsed.

These measures include administration of t-PA, a thrombolytic agent that can be used to improve stroke outcomes, receipt of medications that can help prevent blood clots, and measures that assess rehabilitation services provided by speech and language therapists.

David Knowlton, president and CEO of the New Jersey Health Care Quality Institute and Anne Alexandrov, PhD, APRN, CCRN, FAAN, professor and program director of NETSMART, the Neurovascular Education & Training in Stroke Management & Acute Reperfusion Therapies, co-chaired NQF’s steering committee on the prevention and management of stroke across the continuum of care.

“By endorsing these measures, NQF has taken a solid step forward toward ensuring evidence-based practice that supports the needs of stroke patients across the continuum of care,” said Alexandrov. “As the third most common cause of death and the number one cause of adult disability, stroke is a disease that commands our attention.”

Measures were developed by the American Speech Language Hearing Association, the American Stroke Association, the Centers for Disease Control & Prevention, and the Joint Commission.

Immunization

This set of three NQF-endorsed voluntary consensus standards aims to measure influenza and pneumococcal vaccination coverage among nursing home residents and influenza vaccination of healthcare personnel and brings measurement of vaccination practices in line with national guidelines. The endorsement of these measures broke new ground for NQF because the explicit focus was on measure harmonization based on standard measure specifications for flu and pneumococcal immunizations consistent with national guidelines.

Roger Baxter, MD, co-director of the Vaccine Study Center at Kaiser Permanente in California, and Jane R. Zucker, MD, assistant commissioner at the New York City Health Department, co-chaired NQF’s influenza and pneumococcal immunizations steering committee.

“The harmonization of measures achieved by the NQF committee will hopefully result in a more clear understanding of the utilization of these important vaccines,” said Baxter.

“Setting standards for how we measure vaccination rates will help us raise the bar,” said Zucker.  “Not only will we know how many people are accepting vaccinations, but also how many are refusing them. This way we can improve our strategies for vaccination, set targets for improving rates, and measure our success. In addition, the new health care worker standard is an important first step to increasing vaccination rates in this group, which would reduce the spread of influenza in health care settings.”

Measures were developed by the Centers for Disease Control & Prevention and the Centers for Medicare & Medicaid Services.

How to Appeal

NQF is a voluntary consensus standards-setting organization. Any party may request reconsideration of the recommendations, in whole or in part, by notifying NQF in writing via email no later than September 1 (appeals@qualityforum.org). For an appeal to be considered, the notification email must include information clearly demonstrating that the appellant has interests that are directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests.

Funding

This work was conducted under a contract from the Centers for Medicare & Medicaid Services.

MEASURES ENDORSED BY NQF

Please visit our website at www.qualityforum.org to read the full specifications for all of the new NQF-endorsed voluntary consensus standards and read NQF’s research recommendations.

     Clinician-Level Cancer Care

• Hematology: Myelodysplastic syndrome (MDS) and acute leukemias – baseline cytogenetic testing performed*
• Hematology: Documentation of iron stores in patients receiving erythropoietin therapy*
• Hematology: Chronic lymphocytic leukemia (CLL) – Baseline flow cytometry*
• Hematology: Multiple myeloma – treatment with bisphosphonates*
• Radiation oncology: Treatment summary documented and communicated*
• Medical oncology: Radiation dose limits to normal tissues*
• Medical oncology and radiation oncology: Plan of care for pain*+ AND
• Medical oncology and radiation oncology: Pain intensity quantified*+
• Medical oncology: Chemotherapy for stage IIIA through IIIC colon cancer patients*
• Oncology: Cancer stage documented*
• Medical oncology: Hormonal therapy for stage IC through IIIC, ER/PR positive breast cancer
• Prostate cancer: Three-dimensional radiotherapy*
• Prostate cancer: Avoidance of overuse measure – isotope bone scan for staging low-risk patients*
• Prostate cancer: Adjuvant hormonal therapy for high-risk patients*
• Pathology: Breast cancer resection pathology reporting - pT category (primary tumor) and pN category (regional lymph nodes) with histologic grade*
• Pathology: Colorectal cancer resection pathology reporting - pT category (primary tumor) and pN category (regional lymph nodes) with histologic grade*

     Clinician-Level Infectious Diseases

• Hepatitis C: Testing for chronic Hepatitis C – Confirmation of Hepatitis C viremia*
• Hepatitis C: Counseling regarding use of contraception prior to antiviral treatment*
• Hepatitis C: Hepatitis C RNA testing before initiating treatment*+ AND
• Hepatitis C: HCV genotype testing prior to treatment*+
• Hepatitis C: Prescribed antiviral therapy*
• Hepatitis C: HCV RNA testing at week 12 of treatment*
• Hepatitis C: Hepatitis A vaccination*+ AND
• Hepatitis C: Hepatitis B vaccination *+
• Hepatitis C: Counseling regarding risk of alcohol consumption*
• Screening foreign-born adults for chronic Hepatitis B*
• HIV/AIDS: Medical visit*
• HIV/AIDS: CD4+ cell count*
• HIV/AIDS: Pneumocystis jiroveci pneumonia (PCP) prophylaxis*
• Adolescent and adult patients with HIV/AIDS who are prescribed potent antiretroviral therapy*
• HIV RNA Control after six months of potent antiretroviral therapy*
• HIV/AIDS: TB screening*
• HIV/AIDS: Chlamydia and gonorrhea screening*
• HIV/AIDS: Syphilis screening*
• HIV/AIDS: Hepatitis B screen*
• HIV/AIDS: Hepatitis B vaccination*
• HIV/AIDS: Screening for high-risk behavior*
• HIV/AIDS: Hepatitis C screen*
• HIV/AIDS: Screening for injection drug use

       Perioperative Care

            Clinician-Level

• Perioperative temperature management – clinician-level (harmonization)*
• Recording of clinical stage prior to surgery for lung cancer and esophageal cancer resection*
• Participation in a systematic national database for general thoracic surgery
• Recording of performance status prior to lung or esophageal cancer resection*
• Pulmonary function tests (PTF) before major anatomic lung resection*
• Risk-adjusted morbidity: Length of stay > 14 days after elective lobectomy for lung cancer
• Risk-adjusted morbidity and mortality for esophagectomy for cancer*
• Discontinuation of prophylactic antibiotics (non-cardiac procedures)*
• Selection of prophylactic antibiotic – First OR second generation cephalosporin*
• Timing of antibiotic prophylaxis – ordering physician*
• Anesthesiology and critical care: Prevention of catheter-related bloodstream infections (CRBSI) – central venous catheter (CVC) insertion protocol
• Perioperative anti-platelet therapy for patients undergoing carotid endarterectomy
• Use of patch during conventional endarterectomy*

Facility-level Surgery and Anesthesia

• Postoperative DVT or PE
• Protocol for glycemic control with IV insulin implementation
• Surgery patients with perioperative temperature management (SCIP Inf 7)
• Urinary catheter removal on post-operative day #1 or post-operative day #2

    Clinician-Level Nonphysician Professionals

• Diabetic foot & ankle care, ulcer prevention – evaluation of footwear*
• Diabetic foot & ankle care, peripheral neuropathy – neurological evaluation*
• Screening for clinical depression and follow-up*
• Universal documentation and verification of current medications in the medical record*
• Pain assessment prior to initiation of patient therapy and follow-up*
• Adult weight screening and follow-up*
• Functional status change for patients with knee impairments*
• Functional status change for patients with hip impairments*
• Functional status change for patients with foot/ankle impairments*
• Functional status change for patients with lumbar spine impairments*
• Functional status change for patients with shoulder impairments*
• Functional status change for patients with elbow, wrist, or hand impairments*
• Functional status change for patients with general orthopedic impairments*
• Change in basic mobility*
• Change in daily activities*

       Stroke

• DVT prophylaxis
• Antithrombotic therapy at discharge
• Atrial fibrillation discharged on anticoagulation
• t-PA (thrombolysis) administration
• Receive antithrombotic therapy by end of hospital day #2
• Discharged on statin medication
• Given education or educational materials
• Patients with ischemic or hemorrhagic stroke – assessed for rehabilitation
• Functional communication measure: writing*
• Functional communication measure: swallowing*
• Functional communication measure: spoken language expression*
• Functional communication measure: spoken language comprehension*
• Functional communication measure: reading*
• Functional communication measure: motor speech*
• Functional communication measure: memory*
• Functional communication measure: attention*
• Acute stroke mortality rate

    Immunization

• Influenza vaccination coverage among healthcare personnel*
• Influenza vaccination of nursing home/skilled nursing facility residents
• Pneumococcal vaccination of nursing home/skilled nursing facility residents
• Standard measure specifications for influenza and pneumococcal immunizations

* Time-limited
+ Paired

The mission of the National Quality Forum is to improve the quality of American healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs. NQF, a non-profit organization (www.qualityforum.org ) with diverse stakeholders across the public and private health sectors, was established in 1999 and is based in Washington, DC.