Performance Measurement Orientation To schedule a presentation of “Performance Measurement Orientation” for your organization staff and/or collaborators, contact the National Partnership at

Presentation Overview 1. The Case for Improving Health Care Quality 2. The Role of Performance Measurement in Improving Care 3. Overview of Performance Measures 4. The Performance Measurement Process – development, consensus, implementation 5. Consumer Perspective on Performance Measurement

Poor Quality Care Is Rampant 50/50 chance of getting the right care Medical errors Variations in care Disparities Lack of patient empowerment

Improving Health Care Quality Would… Save lives Prevent errors Lower costs (save approximately $420 billion annually) Prevent infections Empower patients

What Gets Measured Improves. What We Know About Health Care…

What Gets Measured And Reported Improves Even More!

Additional Benefits of Performance Measurement Accountability—tying doctor’s success to results, rewarding results. Transparency—recognizing doctors and hospitals who perform well and motivating those who don’t. Innovation—generating new knowledge to improve medical treatment. Information—providing patients and health care purchasers with valuable information for decision- making purposes.

Performance Measurement Basics What are performance measures? A way to evaluate the care provided by doctors and hospitals based on accepted national guidelines.

Access to medical care – doctors and hospitals Processes of care -- the way care is given Patient’s results after treatment (outcomes) Patient experiences with care Use of medical services Performance Measurement Basics (cont.) What do performance measures evaluate?

Performance Measurement Basics (cont.) What are standardized performance measures? Standardized performance measures are a system of tracking how well doctors are providing patient care – in a way that allows for comparisons between doctors, clinics and/or hospitals.

Sample Performance Measures Measurement ExampleWhy the Measure is Needed Heart Attack – Right Treatment Number of heart attack patients out of 100 that receive beta blocker medication within 24 hours of arrival at the hospital. The early use of beta blockers reduces death. However, beta blockers continue to be under- prescribed for older patients in the hospital for heart attack. Death or Disability Percentage of patients who die or suffer a serious disability due to a medication error. Approximately 7,000 people die from medication errors each year – this is about 16% more deaths than the number attributable to work-related injuries. Patient/Physician Communication Number of patients out of 100 who say their doctor listens to them carefully. Patients who understand their doctors’ instructions are more likely to be aware of their health problems, understand their treatment options, change their behavior, and take their medicine at the right time. Research shows that effective patient-physician communication can improve a patient's health.

What Can Performance Measures Tell Us? Overuse Underuse Misuse

Measurement Math = 50% 2 = Denominator: every child under the age of two that is seen at the clinic or doctor group = Numerator: the number of children who received their shots from a clinic or doctor group.

Performance Measurement: It’s Not Just Math Determining the measures Developing the measures and risk adjustment Getting the data Verifying and auditing the data Combining the data Applying risk adjustment if necessary

The Evolution of Performance Measurement Accreditation —hospitals and health plans Internal quality improvement and benchmarking— hospitals and health plans Efficiency— utilization improvement of underused or overused services Benefit design— employers and health plans Contracting and pay- for-performance— employers and health plans Consumer decision-making Quality improvement and benchmarking— individual physicians

Performance Measurement Process: A Disconnect Between Ideal and Reality Ideal: Measures Created Measures Accepted Measures Implemented Quality Improves Reality: Measure Landscape is Complex A flowchart of measures implemented by various health care organizations

National Quality Forum The Actual Performance Measurement Process Implementation by accrediting bodies, physician groups, purchasers, etc. ResearchersAHRQJCHAONCQA Measure Development Standards Process All Stakeholders Consensus Process

The State of Performance Measurement: Where Are We Now? Measure TypeMeasure SetHospital NQF- Endorsed Measures Physician NQF- Endorsed Measures SafetyNQF Safe Practices (Leapfrog) Infections/Errors AHRQ Patient Safety Indicators Nursing Indicators √√√√ Timeliness ProcessWide set of conditions√√√ Effectiveness- Outcomes Mortality, morbidity, functional health status √√√ Cost-EfficiencyResource use Cost to payers Multiple time frames  EquityMeasures for population subgroups  Patient CenterednessCG-CAHPS/H-CAHPS√√√ Key:  =no measurement set;  =minimal measure set;  =partial measure set;  =robust measure set *Table developed by Consumer Purchaser Disclosure Project:

The Consumer Perspective on Performance Measurement Ideal performance measures include: 1.Measures that are common to all patient interaction with doctors, nurses, and other health care providers (cross-cutting measures). 2.Measures that evaluate the results of care (outcomes measures). 3.Measures for specialty care, particularly for specialties where patients have more time to choose a provider—such as obstetrics and elective surgery.

The Consumer Perspective on Performance Measurement (cont.) Ideal performance measures include: 4.Comprehensive measures that look at patient care over the long term – not just for one visit – and are collected at the patient level. 5.Measures that provide performance information in various health care settings – physician, hospital, physician group levels. 6.Measures that evaluate care for specific groups of people, for example, by race, ethnicity, language or gender.

How the Measures Are Reported Is Key  Make it easier to understand; use plain language  Provide an explanation of the rationale and goals of the report; assist with interpretation  Increase motivation

Why is the Consumer Advocate’s Role in Performance Measurement Important? Historically, the drivers of health care quality improvements have been health care providers, employers, researchers, and health plans; the end-users – consumers – have been largely absent. As a result, often times initiatives aimed at improving health care quality fail to reflect the needs of the general public. Advocates represent the target audience of data measures as well as the “game changer” force that can help influence the performance measurement projects.

Inform consumers and patients of the importance of measurement. Inform consumers and patients of the available measurement reports; focus on best use of reports. Represent the consumer and patient voice in community measurement initiatives. Why is the Consumer Advocate’s Role in Performance Measurement Important?

Communicating with Consumers The Problem *In every community, both good and bad care is being provided in hospitals and doctors’ offices. There are too many mistakes and too much miscommunication in the health system that can harm people. Solutions *Providing information on the quality of care local doctors and hospitals provide will help consumers make better decisions about where to get care for themselves and their family. *Giving people information helps them be better partners with their doctors in managing their own health. Call to Action *People can improve their care by learning more about their doctors and their own conditions—asking questions, sharing their medical history, making sure they understand their doctor’s recommendations, and taking the necessary steps to feel better sooner.