National Voluntary Consensus Standards For Hospital Care: Outcomes and Efficiency Phase II
Current Activity: The 2nd appeals period closed December 13, 2010.
The Opportunity
As we move towards a broader view of hospital-based care, there is a need for measures that specifically address the outcomes and efficiency of care. Phase II of this project recognizes the growing recognition of the critical role that the hospital plays as the focal point for coordination to ambulatory care, home care, and skilled nursing facilities necessitates an examination of measures that have a view of care that reaches beyond the walls of the hospital. For example, the alarming rate of readmissions among Medicare beneficiaries suggests the need for both improved processes in the hospital at transition points, as well as tracking of the follow-up visits to the healthcare home.
About the Project
Phase I of the Hospital Care: Outcomes and Efficiency Measures project began in May of 2008. Phase II of the project began in October 2008.
Objective
This project seeks to identify measures that specifically address the outcomes and efficiency of hospital care. Further, the growing recognition of the critical role that the hospital plays as the focal point for transitions to ambulatory care, home care, and skilled nursing facilities necessitates measures that take a broader view of results beyond the walls of the hospital (e.g., 30 to 90 days).
Process
Candidate measures will be considered for NQF endorsement as national voluntary consensus standards. Agreement will be developed through NQF’s Consensus Development Process (CDP, version 1.8). This project involves the active participation of representatives from across the spectrum of healthcare stakeholders and is guided by a steering committee.
Funding
The project is being conducted under a contract from the Centers for Medicare & Medicaid Services.
Related NQF Work
Hospital Care: Outcomes and Efficiency, Phase I
Contact Information
Karen Pace at 202-783-1300 or hospitaloutcomes@qualityforum.org .
NQF seeks to endorse measures of hospital outcomes that reach outside of the hospital walls. These could include measures of quality of the hospital transition, improvement in health-related quality of life, palliative care symptom control, and surgical outcomes.
The project Steering Committee, representing the full range of stakeholder perspectives, is overseeing both phases of this project.
The steering committee decided to organize a Technical Advisory Panel (TAP) for its Phase II work. The TAP undertakes the technical evaluation of the Phase II candidate measures and makes recommendations to the Steering Committee on the scientific acceptability of the measure properties. Also, it provides general guidance on evaluating the scientific acceptability of outcome measures.
Steering Committee Roster
Technical Advisory Panel Roster
For additional information on the Steering Committee formation process, including specific information on conflicts of interest and required time commitment, please refer to the Call for Nominations documents.
Call for Nominations, Nomination Form, Disclosure of Interest Form (Word)
NQF received 37 measures to review for potential endorsement as national voluntary consensus standards. Submissions were accepted from October 2 - November 21, 2008.
Table of Submitted Measures
The Steering Committee met in person and by conference call numerous times from November 2008 through July 2009. The TAP met in February 2009. They reviewed all submissions and communicated with measure developers as needed to determine the measures to recommend for endorsement. Following this review period, the recommended measures were made available for public and member comment.
Measure evaluation table (with the measure submission forms)
Steering Committee and TAP (All meeting summaries)
The Technical Advisory Panel met in-person in Washington, DC. The purpose of the meeting was to evaluate the candidate measures using the NQF measure evaluation criteria, and to make recommendations to the Steering Committee as to which measures were suitable to be considered as voluntary consensus standards. In addition, the panel was asked to begin to identify issues regarding evaluation of outcome measures that would need to be clarified.
February 4-5, 2009 TAP Meeting Summary and Measure Evaluations
The Steering Committee met in-person in Washington, DC. The purpose of the meeting was to complete the evaluation of the candidate measures, including review of the measure evaluations and recommendations of the Technical Advisory Panel; to make recommendations on which measures were suitable to be voluntary consensus standards; and review plans for those measures due for maintenance.
March 3-4, 2009 Meeting Summary and Measure Evaluations
The Steering Committee met via conference call. The purpose of the call was to review the recommended candidate measures in comparison to similar measures previously endorsed by NQF, and to identify any remaining issues that could impact the Steering Committee's recommendations.
April 13, 2009 Conference Call Summary and Measure Evaluations
The Steering Committee met via conference call. The purpose of the call was to conduct measure maintenance on the Hospital CAHPS survey, and to review three Psychiatric Process measures.
July 2, 2009 Meeting Agenda (PDF)
Meeting Summary (PDF)
Voting ended at 6 pm ET on July 9, 2009. Additional documents related to this vote, including a list of the comments submitted, the measure evaluation table, and summaries of the steering committee and technical advisory panel meetings, are available in the project details.
Voting Draft Report
Sample Ballot
At their meeting on July 15 and 16 the CSAC voted to endorse 10 of the proposed 11 measures for hospital outcomes.
On September 8, 2010 the CSAC reviewed six measures for which the Board had deferred action pending the results of further study. The CSAC voted to approve endorsement of 3 of the 6 measures.
NQF's Board of Directors ratified the CSAC’s decision to endorse four measures for hospital outcomes.
Endorsed Measures:
- 0536 - HOE-010-08: 30-Day All Cause Risk-Standardized Percutaneous Coronary Intervention (PCI) Mortality Rate for Patients with ST Segment Elevation Myocardial Infarction (STEMI) or Cardiogenic Shock
- 0535 - HOE-009-08: 30-Day All Cause Risk-Standardized Percutaneous Coronary Intervention (PCI) Mortality Rate for Patients Without ST Segment Elevation Myocardial Infarction (STEMI) and Without Cardiogenic Shock
- 0534 - HOE-008-08: Hospital-Specific Risk-Adjusted Measure of Mortality or One or More Major Complications Within 30 Days of a Lower Extremity Bypass (LEB)
- 0533 - HOE-015-08 Postoperative Respiratory Failure (PSI#11)
The Board deferred action (up to October 2010) on the six Leapfrog survival predictor measures, pending the results of further study.
NQF's Board of Directors ratified the CSAC’s decision to endorse three of the measures for which action had been deferred for further study.
- 0736 - HOE-021-08 Survival Predictor for Abdominal Aortic Aneurysm (AAA)
- 0737 - HOE-023-08 Survival Predictor for Esophagectomy Surgery
- 0738 - HOE-024-08 Survival Predictor for Pancreatic Resection Surgery
Board of Directors Memorandum (PDF)
The public was given 30 days for the opportunity to appeal the decision to endorse voluntary consensus standards. There were two separate appeals periods for this project.
The public had 30 days to appeal the decision to endorse voluntary consensus standards. No appeals were filed.
The public had 30 days to appeal the final decision to endorse three measures that address the outcomes for survival predictor measures. A second appeals period closed on December 13, 2010.
