1. Patient engagement in Quality of Care Measurement
Reena Duseja, MD MS
Director, Division of Quality Measurement
Center for Clinical Standards & Quality 1

2. General Principles Alignment with CMS Quality Strategy
Alignment with Commercial payers and states
Address performance gaps
Evidence-based measure concepts
Scientific rigor
Patient/caregiver and front line clinician inclusion
Rapid-cycle development
Prioritize Patient-reported outcomes
Monitor disparities and unintended consequences

3. Strategic Vision Measures should be:
Patient Centered with a focus on patient experience and preferences
High Value with an emphasis on –
outcomes for patients and spanning the care continuum
Current with clinical practice updates
Applicable to other payers and across care settings
Agile in their development, with an emphasis on innovation

4. Priorities for Measure Development by Quality Domain
Clinical Care
Measures incorporating shared decision-making
Outcome and Patient-reported Outcome Measures
Cross-cutting measures (patients with MCCs)
Focused measures for specialties that have clear gaps
Safety
Measures of diagnostic accuracy
Medication safety

5. Priorities for Measure Development by Quality Domain (continued)
Care Coordination
Assessing team-based care
Effective use of new technologies
Patient and Caregiver Experience
Disease specific and cross-cutting PROMs
Patient experience surveys (general and specialty-specific where needed)

6. Priorities for Measure Development by Quality Domain (continued)
Population Health and Prevention
Developing or adapting outcome measures at a population level to assess the effectiveness of the health promotion and preventive services delivered by professionals
Affordable Care
Overuse measures
Episode based resource use

7. Person & Family Engagement Network Composition
Fiscal Year 2017 began with 43 members and as of 9/1/17 has 68 members

8. Conditions Represented in Person and Family Engagement Network Member Experiences
Palliative and end-of-life care; advance directives
Cardiac Care: heart attack and failure, coronary artery disease, heart transplant, cardiac rehab
Cancer Care: breast cancer, non-Hodgkin’s lymphoma, colorectal cancer, ovarian cancer
Family Caregiving
Disability/Chronic Illness: multiple sclerosis, spinal muscular atrophy, Spastic quadriplegia Cerebral Palsy, Ehlers-Danlos syndrome, down syndrome, kidney disease, endometriosis, chronic pain
Health care chaplaincy/ministry
Mental health conditions and comorbidities
Hip/joint replacement
Diabetes
Health care disparities: race, ethnicity, socioeconomic status, sexual orientation
Aging
Patient Safety

9. Engagement mechanisms CMS uses in Patient Engagement
Technical Expert Panels
Network-Wide Surveys
Targeted one to one cognitive interviews
Listening sessions and Surveys
Targeted Working Group and Survey

10. Role of Patient Reported Outcome (PRO) Measures
Consistent with the National and CMS Quality Strategies, CMS has embarked on multiple PRO-based measure development projects
These projects have created opportunities for engaging stakeholders and advancing clinical practice, which has been traditionally slow to incorporate PROs.

11. Using PRO data to build quality measures ensures that patient’s voice is heard.
The voluntary PRO data collection in the Comprehensive Care for Joint Replacement model is the first demonstration that hospitals recognize the value and importance of collecting PRO data.
Patient’s self-reported pain and functional outcomes after elective knee and hip arthroplasty

12. Lessons learned
Partnering with persons and families means operating outside the “Nine-Five” day
Persons & families have differing needs, preferences, and expectations from one another
Persons & families know best how they should be engaged
Language impacts relationship building and engagement success

13. Lessons Learned Person & Family Engagement vision and impact
One-time Network-wide engagements can have significant impacts
Successful engagement requires an organization-wide person & family engagement vision

14. Contact Information
Reena Duseja, M.D., MS Director, Division of Quality Measurement, Center for Clinical Standards and Quality Chief Medical Officer Centers for Medicare and Medicaid Services