Overview
This project builds upon foundational work on attribution including NQF’s 2016 Attribution: Principles and Approaches and 2018 Improving Attribution Models. It will incorporate findings from NQF’s 2019 Healthcare System Readiness Measurement Framework which identifies concepts for assessing care delivery and the organization of resources prior to, during, and after emergencies. This CMS-funded initiative will advance measurement attribution by considering how novel model designs could incentivize a team-based, system-wide response to emergencies. The outputs of this work will include 1) an environmental scan of current population/geographic-based attribution approaches for quality measures related to high-acuity emergency care-sensitive conditions (ECSCs), supplemented by key informant interviews with experts in the field, and 2) a final report that documents recommendations on the necessary elements, theoretical and empirical approaches for the future development of population/geographic-based quality measurement attribution approaches for high-acuity ECSCs. Findings will support the development of potential future population-based attribution approaches for quality measure that can encourage shared accountability across the multiple entities involved in preparing and responding to emergencies to improve patient outcomes.
The Opportunity
Attribution is defined as the methodology used to assign patients, and their quality outcomes, to providers or clinicians. As the healthcare system increasingly moves towards value-based models of care, measurement attribution must continue to evolve. Many attribution models to date focus on chronic conditions and care coordinated through a central unit. This new CMS-funded work led by NQF will develop a population/geographic-based attribution approach for measures related to ECSCs, such as COVID-19, trauma resulting from shooting or bombing, and other public health emergencies – areas not previously addressed. The ongoing COVID-19 pandemic has presented situations in which opportunities for time-sensitive care are often based on geography rather than health system network affiliation. A new approach in attribution is needed for ECSC-related quality measures to reflect the reality and challenges of saving lives and improving outcomes.
About the Project
Evidence to support the best way to attribute patients during emergencies is limited. Therefore consensus-based recommendations that define the elements of such attribution models and considerations for their development will help advance the measurement of outcomes during emergencies. NQF will convene a multistakeholder Committee to make recommendations for developing geographical/population-based quality measurement attribution models applicable to high-acuity ECSCs. To gather additional feedback, key informant interviews will be conducted, in addition to public commenting periods for the environmental scan and final report.
Objectives
- Provide guidance for developing attribution approaches for quality measurement of health outcomes for patients who receive care from multiple providers during an episode of care
- Develop elements of geographical/population-based attribution approaches applicable to a community-based system response for unplanned high-acuity ECSCs
NQF Process
NQF will convene the multistakeholder Committee for six web meetings over a 12-month period. The Committee will 1) review the environmental scan and themes from key informant interviews; 2) create use cases as concrete examples of how outcomes may be attributed to multiple entities during emergencies; and 3) develop actionable recommendations for population-/geographic-based measurement attribution approaches that encourage coordinated care to improve outcomes during emergencies. The Committee will aim to reach consensus and make recommendations on the necessary elements of population/geographic-based attribution models, theoretical and empirical approaches to attribution, and guidance for the future development of population/geographic-based quality measurement attribution approaches for emergency conditions. Additionally, there is an opportunity for key informant interviews to help shape project recommendations.
Funding
This project is funded under a contract with the Centers for Medicare & Medicaid Services. For information about the availability of auxiliary aids and services for NQF’s federally funded projects, please visit http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.
Related NQF Work
Contact Information
For more information, please contact the project team at Attribution@qualityforum.org. Thank you for your interest in this project.
NQF will convene a multistakeholder Committee to make recommendations for developing geographical/population-based attribution models applicable to quality measurement of high-acuity Emergency Care Sensitive Conditions (ECSCs), such as COVID-19, trauma resulting from shooting or bombing, and other public health emergencies.
