This NQF project seeks to identify and endorse ambulatory care measures suitable for both public accountability and quality improvement that can be derived primarily from clinically enriched administrative data.
In recent years, NQF has endorsed more than 150 clinician-level ambulatory care measures which rely heavily on medical record reviews or physician-directed coding to assess performance. It is anticipated that performance measurement will ultimately rely on clinical data available in electronic health records, but it is unclear how long it will take for the quality enterprise to make the transition. In the interim, many measurement programs rely on electronic, administrative data. Performance measures that can be derived from ambulatory administrative data alone are very limited, and concerns have been raised about the accuracy and reliability of these data and measures. Fortunately, progress has been made towards improving these measures through the addition of laboratory and pharmacy data and other electronic clinical data, which when combined with administrative data, provide a rich source of information for the assessment of some aspects of performance. A variety of stakeholders stress the urgent need for measures based on readily available and feasible data sources.
In this project, NQF will consider quality measures for ambulatory care based on administrative data, enriched by laboratory and pharmacy data and other electronic clinical data, that can provide additional tools for purchasers, health plans, consumers, clinicians and other stakeholders working to create more feasible approaches to ongoing performance measurement and quality improvement.
NQF will consider candidate performance measures for a wide variety of ambulatory care conditions appropriate for use at the individual clinician, group, health plan, system, and community level. For candidate measures based on enriched administrative data that are similar to current NQF-endorsed measures, harmonization will need to be addressed.
The candidate measures will be considered for NQF endorsement as voluntary consensus standards. Agreement around the recommendations will be developed through NQF’s formal Consensus Development Process (version 1.8). This project, like all NQF activities, involves the active participation of representatives from across the spectrum of healthcare stakeholders and is guided by a Steering Committee.
Funding for this project has been provided by Aetna Foundation, United Health
Foundation, Cigna Foundation, Wellpoint Foundation and the Pacific
Business Group on Health.
For more information, contact Reva Winkler, MD, MPH at 202.783.1300 or via email at RWinkler@qualityforum.org