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Ensuring A Person-Centered Approach to Quality Measurement Emma Kopleff Senior Policy Advisor NCCS Cancer Policy Advocate Training November 14, 2014.

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Presentation on theme: "Ensuring A Person-Centered Approach to Quality Measurement Emma Kopleff Senior Policy Advisor NCCS Cancer Policy Advocate Training November 14, 2014."— Presentation transcript:

1 Ensuring A Person-Centered Approach to Quality Measurement Emma Kopleff Senior Policy Advisor NCCS Cancer Policy Advocate Training November 14, 2014

2 About us 2  National Partnership for Women & Families  Non-profit, consumer organization with 40 years’ experience on issues related to healthcare, workforce, and anti- discrimination  Consumer-Purchaser Alliance (C-P Alliance)  Collaboration of leading consumer and employer organizations  Vision is a high quality, affordable, person-centered healthcare system  Since 2002, C-P Alliance has shaped delivery and payment reform through the use of meaningful quality measures

3  What is health care quality and what does it mean to patients?  What are quality measures and how are they used?  What are priority areas of cancer care where quality measurement could better support patient, family and caregiver needs? Today’s Goal: Answering Key Questions 3

4 Defining Health Care Quality and What it Means to Patients 4

5 Quality in the U.S. Healthcare System Is Not What It Should Be 5

6  Variation in mammogram rates in female patients aged 65- 69:  58% in Oklahoma  76 % in Massachusetts  65.4 % nationally  Patients Are Not Consistently Receiving Recommended Care  55 % of adults  47 % of children Quality Within the U.S. System: Variation and Inadequacy 6 Sources: Dartmouth Institute for Health Policy and Clinical Change, 2013; McGlynn et. al., 2003; Mangione-Smith et. al., 2007

7 7 Many of us can relate to the notion that:  We are forced to navigate a complex and uncoordinated system  We do not feel fully informed or engaged in decisions about our care  We cannot access the information we need in a way that is easy to understand Patients, Families, and Caregivers’ Needs Are Not Being Met

8 What Quality Means to Us 8 The Right Care At the Right Time For the Right Reason

9 What Is Quality Measurement? 9 Quality Measures 101

10 Quality measures: A way to evaluate and improve care provided by hospitals, doctors, health plans and other health care entities based on accepted national guidelines or evidence Defining Quality Measurement 10

11 Quality Has Been Measured For a Long Time 11  1850s: Florence Nightingale measured infection rates  Early 1900s: Earnest Codman tracked patient outcomes and documented errors  Over the last 20-25 years: demand for standardized, “apples to apples” quality information data availability willingness to integrate into public policy Sources: Mainz J, 2004; Berenson, Pronovost and Krumholz, 2013. l

12 Types of Measures* *See appendix for additional detail 12 Process Outcome Patient Experience Structure

13 Measurement Math: The Simple Version 13 Numerator (ex: Patients within the denominator population who received one or more mammograms during the measurement year) ____________________________________________________________ Denominator (ex: Women 42–69 years of age)

14 The Measurement Development Process 14 Identifying quality issue and evidence Identifying numerator, denominator, exclusions, time window, data source, and other specifications Identifying appropriate use and implementing measure Collecting, verifying and refining data Endorsement from national standards entity 3+ years


16 16 Quality Measurement for Cancer Care

17  Coordinating care is complex  Increases in survivorship introduce challenges across course of illness and recovery  Current state of cancer care quality measurement is limited Cancer Care Has A Unique Set of Quality Challenges 17

18 The majority of cancer care quality measures that currently exist are:  Focused on discrete processes of care  Particular to one cancer type  Not specific to cancer patients but still relevant (e.g., rates of hospital infections) The Current Landscape Misses the Target 18

19 The Desired State 19 The future of measure development and implementation should be:  Understandable, meaningful, and usable by consumers  Outcomes-focused  Based on patient and/or family/caregiver-generated health data

20 Patient-Reported Outcome Measures (PROMs) Are High-Priority 20 PROMs promote a more person-centered approach to quality improvement by:  Providing valuable information otherwise not available  Asking patients for information and engaging with them on the results and interventions

21  Institute of Medicine committee identified key quality gaps for cancer (e.g., patient-reported outcomes, costs of care)  American Society of Clinical Oncology developing PROMs addressing pain and symptom management  MD Anderson Inventory used in clinical practice and research Promising Endeavors Underway To Fill Gaps in Person-Centered Measures 21

22 How Would You Rate the Highest-Priority Gaps? 22 1.Care planning 2.Coordination of care 3.Cross-cutting patient-reported issues 4.Cancer- and stage-specific survival rates 5.Costs of care

23 Ensure the consumer voice is heard:  CMS and CMMI  National Quality Forum  Cancer Experience Registry  The International Consortium for Health Outcomes Measurement Be At the Table 23

24 Visit and sign-up for the Consumer-Purchaser Alliance  Stay up to date on opportunities to serve on committees or comment on quality efforts  Sign-on to comment letters and/or write your own  Join educational webinars and conference calls Collaboration is Key 24

25 Questions? 25

26 For more information Find us: Contact me: Emma Kopleff, MPH Senior Policy Advisor, Consumer-Purchaser Alliance 26


28 Process Measure Examples 28 Doing the right thing at the right time for patients  Examples  Completed mammogram to screen for breast cancer  Recording that vital signs are being monitored

29 Outcome Measure Examples 29 Having an effect on the patient’s health and well- being  Examples  Survival rate  Rate of infections or complications  Quality of life

30 Patient Experience Measure Examples 30 The patient’s own rating of the care received  Examples  The doctor spent enough time with me and answered all of my questions  The hospital gave me information about what to do to manage my care at home

31 31 Structural Measure Examples Assessing features of delivery organizations, including characteristics of care setting, personnel, and/or policies related to care delivery  Examples  Do patients have access to their health information through an electronic interface?  Does an intensive care unit (ICU) have a critical care specialist on staff at all times?

32 32 NameRole National Quality Forum (NQF)Serves as the national measurement endorsement entity and the primary forum for setting measurement priorities and recommending measures for use in federal programs National Committee for Quality Assurance (NCQA)Accredits health plans; certifies programs; measure development The Joint CommissionAccredits hospitals; measure development and implementation Medical specialty societiesOngoing certification requirements; measure development Centers for Medicare & Medicaid Services (CMS)Payer for Medicare and Medicaid, sponsors measure development, implementation and data aggregation Agency for Healthcare Research and Quality (AHRQ)Measure developer (e.g. patient experience measures) LeapfrogTranslates hospital quality information to be easily understood by consumers Key Organizations in the Measurement Enterprise

33  Berenson RA, Pronovost PJ, Krumholz HM. Achieving the Potential of Health Care Performance Measures: Timely Analysis of Immediate Health Policy Issues, May 2013.  Mainz, Jan. Quality Indicators: Essential for Quality Improvement. Int J Qual Health Care,E 2004; Volume 16, Supplement.  McGlynn EA, Asch SM, Adams J, et. al. The Quality of Health Care Delivered to Adults in the United States. N Engl J Med, 2003; 348:2635-2645.  Mangione-Smith R, DeCristofaro A, Setodji C, et. al. The Quality of Ambulatory Care Delivered to Children in the United States. N Engl J Med, 2007; 357:1515-1523  The Dartmouth Institute for Health Policy and Clinical Practice, 2013, Selected Measures of Primary Care Access and Quality—State Level 2010. Available at References 33

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