HIT Policy Committee Quality Measures Workgroup David Lansky Pacific Business Group on Health November 19, 2010

David Blumenthal, Chair, MD National Coordinator for Health IT David Lansky, Pacific Business Group on Health Peter Basch, MedStar Christine Bechtel, National Partnership for Women & Families Tripp Bradd, Skyline Family Practice, VA Russ Branzell, Poudre Valley Critical Access Hospital, CO Helen Burstin, National Quality Forum Neil Calman, Institute for Family Health Carol Diamond, Markle Foundation Timothy Ferris, Partners Healthcare Patrick Gordon, Colorado Regional Health Information Organization David Kendrick, Greater Tulsa Health Access Network, OK Charles Kennedy, WellPoint, Inc. Karen Kmetik, American Medical Association Robert Kocher, McKinsey & Co J. Marc Overhage, Regenstrief Institute Laura Petersen, Baylor University Jacob Reider, AllScripts Cary Sennett, MedAssurant Jesse Singer, NYC Department of Health Paul Tang, Palo Alto Medical Foundation Kalahn Taylor-Clark, Brookings Institute James Walker, Geisinger Paul Wallace, Kaiser Permanente 2 Quality Measures Workgroup Members

Measure ConceptSub-Domain Measures of patient activation, including skills, knowledge, and self- efficacy Self-Management/ Activation Measures of patient self-management Measures of shared decision making or decision quality that address a combination of patient knowledge and incorporation of patient preferences Honoring Patient Preferences and Shared Decision Making Measures of the patient preferences/ experience of care Measure of patient health outcomes, including health risk status, functional health status, and global measures of patient health Patient Health Outcomes Measure of patient access to community resources for improved/ sustainable care coordination Community Resources Coordination/ Connection 3 Patient and Family Engagement Italics indicates a measure concept that has overlap with other Federal goals

4 Clinical Appropriateness Measure ConceptSub-Domain Measure of all cause readmissions and length of stayAppropriate/Efficient Use of Facilities Assessment of ambulatory care sensitive preventable admissions Assessment of the appropriate use of diagnostic imaging procedures, with measures for redundancy, cumulative exposure, and appropriateness Appropriate/Efficient Use of Diagnostic Test Measure of the development of co-morbidities as a result of uncontrolled chronic disease (sequelae of uncontrolled diabetes) Appropriate/Efficient Treatment of Chronic Disease across Multiple Sites of Care Measure of reconciliation of care plan for chronic disease patients across care settings and multiple specialists (process measure) Assessment of appropriate medication treatments, including overuse and/or underuse Appropriate/Efficient Use of Medications Measure of medication use linked to adherence outcomes Assessment of measure usage rates for generic vs. brand name medications Measure of appropriate use of cardioprotective medications—aspirin, angiotensin-converting enzyme inhibitors, and statins—in individuals at high risk of experiencing heart attacks and strokes. Italics indicates a measure concept that has overlap with other Federal goals

5 Care Coordination Measure ConceptSub-Domain Measure of the adherence to a comprehensive care plan in the EHR with an up to date problem list and care plan that reflects goals of care Effective Care Planning Measure of an Advance Care Plan as a product of shared decision making Measure of the success of a self management plan for patients with conditions where a self management plan might reasonably be considered to benefit them Measure of reconciliation of all medications when receiving a patient from different provider Care Transitions Measure of patient and family experience of care coordination across a care transition (e.g. questions within HCAHP surveys) Composite measure of receipt by both the care team members and the patient/caregiver of a comprehensive clinical summary after any care transition Measure of an assessment of timeliness of provider and appropriate response to clinical information, including lab and diagnostic results Appropriate and Timely Follow-Up Italics indicates a measure concept that has overlap with other Federal goals

6 Patient Safety Measure ConceptSub-Domain Measure of adverse drug events through the FDA Adverse Event Reporting System (AERS) database Medication Safety Measure monitoring drug safety for patients who are on chronic medical therapy (e.g.: Warfarin) Measure of patient reported adverse events Measures of process and outcome improvement of hospital associated infections Hospital Associated Events Measures of venous thromboembolism (VTE) prophylaxis and VTE rates Measures of falls events and screening Italics indicates a measure concept that has overlap with other Federal goals

7 Population and Public Health Measure ConceptSub-Domain Measure of use/availability of services that promote healthy lifestyles (smoking cessation, body mass index management, patient health literacy): A) Smoking cessation focused specifically on quit rate for patients within a reporting period. B) Body Mass Index focused specifically on tracking longitudinal change to determine patient outcome. Healthy Lifestyle Behaviors Measure of screening for alcohol use using a validated tool Measure of mental health screening using a validated instrumentEffective Preventative Services Measure of blood pressure focused specifically on tracking longitudinal change to determine patient outcome Measure of glucose monitoring focused specifically on tracking longitudinal change to determine patient outcome Health Equity focuses on measures with no discrepancy when comparing health outcomes among those within priority populations to those not within the priority populations Health Equity Italics indicates a measure concept that has overlap with other Federal goals

8 Other Measure Concept Assess preventable ED visits Assessment of adherence to clinical practice standards (appropriate cardiac/cancer treatments) Assessment of combined quality and cost measures at each level and site of care reflecting potential defects in care Measure of medication error near misses Measure of patient identification errors and near misses Measure of common EHR related errors (mechanism to report EHR related errors and delays in care to improve EHRs) Italics indicates a measure concept that has overlap with other Federal goals