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2. Lou Diamond, MB, ChB, FACP Moderator
President, Quality Healthcare Consultants
Member, Forum Board of Directors

3. National Quality Forum Projects
Presents a 5-part Webinar Series
National Quality Forum Projects
and how they align with
ESRD Activities
Wednesday, July 21, 2017

4. Webinar Objective The National Forum of ESRD Networks presents
this 5-part webinar series providing members
with the opportunity to learn more about
past, current, and future NQF projects
and how they may align with our ESRD activities.
Nine (9) of the NQF projects will be highlighted in this webinar series.
For a complete listing of the NQF projects visit:

5. 5-Part Webinar Series July 21, 2017
Attributions: Principles and Approaches Project
Disparities Project
August 4, 2017
Improving Diagnostic Quality & Safety
All Cause Admissions and Re-Admissions
August 18, 2017
Care Coordination Endorsement Maintenance
Renal Measures Standing Committee
September 1, 2017
Decision Aids
Palliative & End-of-Life Care
September 15, 2017
Population Health
*Webinars convene at 12:00 pm ET

6. Attributions: Principles and
Approaches Project
Presented by: Shane Perry
Disparities Project
Presented by: John Wagner,
Keith Norris, Lynda Ball

7. Shane Perry John Wagner, MD, MBA Keith Norris, MD Lynda Ball
Today’s Presenters
Shane Perry
Executive Director, Heartland Kidney Network (Nw #12)
John Wagner, MD, MBA
Past President, Forum of ESRD Networks
Kings County Hospital Center NY
Keith Norris, MD
MAC Representative, Quality Insights Renal Network 4
David Geffen School of Medicine, CA
Lynda Ball
Quality Improvement Director, HSAG ESRD Network 13

8. Principles and Approaches Project
Attributions:
Principles and Approaches Project
Presented by: Shane Perry

9. Convene multi-stakeholder expert committee
NQF’s Attribution “Final Report”
NQF Committee
26 individuals
Varied organizations and backgrounds (e.g., AARP, Family Practice, Insurance, University)
Approach
Convene multi-stakeholder expert committee
Environmental scan of current attribution models (84 articles)
Develop Attribution Model Selection Guide
Develop recommendations for the field

10. What is Attribution?
“Attribution is defined as the methodology used to assign patients, and their quality outcomes, to provider or clinicians.”

11. Guiding Principles The Committee agreed …
Attribution models should fairly and accurately assign accountability
Attribution models are an essential part of measure development, implementation, and policy and program design.
Considered choices among available data are fundamental in the design of an attribution model
Attribution models should be regularly reviewed and updated
Attribution models should be transparent and consistently applied.
Attribution models should align with the stated goals and purpose of the program.

12. Attribution Model Selection Guide

13. Attribution models should be tested.
Recommendations
Use the Attribution Model Selection Guide to evaluate the factors to consider in the choice of an attribution model.
Attribution models should be tested.
Attribution models should be subject to multi- stakeholder review.
Attribution models should attribute results to entities who can influence care and outcomes.
Attribution models used in mandatory public reporting or payment programs should meet minimum criteria.

14. Resources
Attribution: Principles and Approaches Project Final Report Attribution Model Selection Guide Case Study

15. Presented by: John Wagner, Keith Norris, Lynda Ball
Disparities Project
Presented by: John Wagner, Keith Norris, Lynda Ball

16. Definitions
Health Disparity – particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion” (Healthy People 2020)
Healthcare disparity – differences in healthcare quality, access, and otcomes adversely affecting members of racial and ethnic minority groups and socially disadvantaged populations (NQF 2012)

17. Social Determinants of Health
Social Risk Factors
Socioeconomic status
Education
Income
Occupation
Sociodemographic
Age
Race
Ethnicity
Primary Language
Social Determinants of Health
Conditions in the environment

18. Measures
Clinical health outcomes
Economic outcomes
Performance improvement
Public accountability
Focus is on role of healthcare services and interventions
For comparisons of same – NQF uses risk adjustment
Prior to 2014 SES contribution was assessed by stratification
After 2014, measures development underwent trial of social risk factor adjustment

19. Principles
Assess concept of relationship between outcome of interest and social risk factors
Assess empirical basis of this relationship
Specify SDS variables that were available/used
Criteria and statistical methods used to select patient factors
Results of analysis
Rationale behind selection of SDS factors
Discrimination calibration statistics of risk model
Disparities Standing Committee was given oversight

20. Results
303 measures
126 outcome or intermediate outcome measures
93 with risk adjustment
65 conceptual basis for social risk factor adjustment
43 small effect- not included
21 submitted had adjustment
17 endorsed

21. Renal Measures & Social Risk
SRR for Dialysis Facilities
Significant but small effect: not included
2977 – Standardized Fistula Rate
2979 – STrR
0369 – SMR
Race, ethnicity included in model

22. Healthcare Disparities
Disparities in healthcare related to race, ethnicity, and socioeconomic status that continue to persist across all National Quality Strategy priorities:
Poor households received worse care than people in high-income households for about 60 percent of quality measures
African Americans, Hispanics, and American Indians and Alaska Natives received worse care than whites for about 40 percent of quality measures
Asians and Pacific Islanders received worse care for about 30 percent of the measures

27. Implement health equity measurements
Incentivize health equity through payment reform
Support organizations that disproportionately serve individuals with social risk factors
Develop and implement demonstration projects with rigorous evaluation partnering with equity researchers

28. Disparities Project Report
Resources
Disparities Project Report

29. Questions for the Presenters?
Questions/Comments:
Submit questions and comments via the Questions panel.
Note: Today’s presentation is being recorded and will be posted on the Forum website:

30. Thank you for attending
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Recording, slides and supporting documents will be available at the Forum website:
Thank you for attending