“NQF’s report
on attribution and its accompanying guide (PDF) provide
foundational guidance for the healthcare system amid escalating financial
stakes,” said Helen Darling, MA, NQF’s interim president and CEO. “It’s
critical that we can accurately identify who is accountable for patients’ care as
we work to improve value without sacrificing quality.”
Attribution models are essential parts of measure
development and implementation, as well as policy and program design. Currently,
there is a wide range of such models in use across the nation, and limited
information about model specifics in some cases, prompting concerns from
providers and other accountable entities that some models may inaccurately
assign accountability for patients or outcomes, as patients see different
providers or receive care from teams of clinicians.
Funded by the U.S. Department of Health and Human Services,
NQF convened a multistakeholder Committee of 26 researchers and clinicians to
develop a guide for measure developers and other stakeholders who are creating
attribution models. The Committee also made recommendations to improve
standardization, transparency, and accuracy among attribution models, including
that:
The Attribution Model Selection Guide should be
used to evaluate the factors to consider in the choice of an attribution model.
Attribution models should be tested, subject to
multistakeholder review, and should attribute results to entities that can
influence care and outcomes.
Attribution models used in mandatory public
reporting or payment programs should meet minimum criteria.
“Much more work is needed to understand the complex issue of
attribution and get to more transparent, standardized models that allow for fair
evaluation and comparison of models, but this foundational work is an excellent
beginning,” said Helen Burstin, MD, MPH, NQF’s chief scientific officer.
This important report, and the guide to attribution model
selection, is just one way that NQF is helping to advance measurement science
in a rapidly evolving health system. In another recently completed project,
NQF provided guidance for minimizing unnecessary variation across similar
measures that add reporting burden for providers and make performance
comparisons difficult.
