1. HIT Policy Committee Quality Measures Workgroup Tiger Team Summary David Lansky, PhD Pacific Business Group on Health October 20, 2010

2. Care Coordination –Tim Ferris, chairperson –Marsha Lillie-Blanton, Helen Burstin, Daniel Green, Rainu Kaushal, David Kendrick, Laura Peterson, Eva Powell, Martin Rice, Sarah Scholle, James Walker Efficiency Including Underuse and Overuse –Charles Kennedy and Robert Kocher, chairpersons –Richard Bankowitz, Niall Brennan, Kate Goodrich, Rob Greene, Karen Kmetik, Jon White Patient Safety –Neil Calman, chairperson –Peter Basch, Tripp Bradd, Russ Branzell, Peter Briss, Marc Overhage, Jacob Reider Patient and Family Engagement –Christine Bechtel and David Lansky, chairpersons –Michael Barry, Susan Edgman-Levitan, Judy Hibbard, Lew Kazis, Gene Nelson, Dana Safran, Paul Tang, Kalahn Taylor-Clark, Paul Wallace, Jim Weinstein Population and Public Health –Jessie Singer, chairperson –Ahmed Calvo, H. Westley Clark, Theresa Cullen, Carol Diamond, Patrick Gordon, Cary Sennett, Steve Solomon Methodological Issues –David Baker, Helen Burstin, Bob Dolin, Abel Kho, Ross Lazarus, Dan Malone, John Moquin, Karen Pace, Phil Renner, Mitra Rocca, Danny Rosenthal, Mark Weiner 2 Quality Measures Workgroup Tiger Teams

3. The Care Coordination tiger team identified four priority sub-domains to focus their efforts. –Effective Care Plans—An effective care plan is a partnership between the patient, his/her family, and the health care team. This may be known as a self management plan. –Care Transitions—A care transition is the movement of a patient between health care providers or health care settings. A care transition occurs anytime there is a patient handoff. –Appropriate and Timely Follow-Up— Appropriate and timely follow-up includes the response from the recipient (physician), such as taking a follow-up action, and acknowledgment of the receipt of the information to the patient and/or sender (specialty provider, etc). –Intervention Coordination—Intervention coordination includes medication management and intervention management, such as diagnostic imaging, testing and other services (OT/PT). Coordination should be appropriate, affordable, and be communicated to the patient. 3 Care Coordination

4. 4 Sub-DomainMeasure Concepts Effective Care Plan Care plan is defined as a partnership between the patient, his/her family, and the health care team. This may be known as a self management plan. Comprehensive Clinical Summary, including summary of treatment for adults and children with chronic conditions (build on Stage 1 MU Measure for Clinical Summary) Self Management Plan – Adults and children with leading conditions Advance Care Plan (build on Stage 1 MU Measure for advance care plan) Palliative Care Plan (symptom management, family engagement) Care Transitions The movement of a patient between health care providers or health care settings. Elements of successful care transitions (medication reconciliation, problem list, diagnostics) Transition between settings of care (inpatient to outpatient, PCP to Specialist or any referral between outpatient services) Transition experience (patient focused measures) Outcomes of poor care transitions (readmissions) Care Coordination

5. 5 Sub-DomainMeasure Concepts Appropriate and Timely Follow-Up Response from the recipient (physician), such as taking a follow-up action and acknowledging receipt of the information to the patient and/or sender (specialty provider, etc) Appropriate medication reconciliation for leading conditions for all transitions and intervals between transitions Provider follow-up on lab and diagnostic results Patient follow up after care transitions Intervention Coordination Intervention Coordination will include medication management and intervention management, such as diagnostic imaging, testing, and other services (OT/PT). Coordination in this category should be appropriate, affordable and be communicated to the patient. Medication Management (including reconciliation) Diagnostic Management Communication with Patient Patient Experience Care Coordination

6. The Efficiency tiger team identified five sub-domains to focus their efforts. –Person-Centered Better Care— Measures that show impacts to patients as they move through the entire care delivery system in an efficient manner. –Proven Care— Measures evaluating the use of effective care based on practice guideline. –Leading Conditions: Longitudinal Care Dashboards— Measures related to Leading Conditions which would enable the creation of a longitudinal dashboard that follows patient progress, including medications, diagnostics, proven care, readmissions, functional status, and patient education. –Value-Based Population and Preventative Health— Measures focused on effective use of preventative health measures. –Appropriate Care— Measures that focus on underused clinical tools or stinting of care. 6 Efficiency Including Underuse and Overuse

7. 7 Sub-DomainMeasure Concepts Person-Centered Better Care Measures that show impacts to patients as they move through the entire care delivery system in an efficient manner. Readmission Diagnostic Imaging Proven Care Measures evaluating the use of effective care based on practice guidelines Medication Generic Medication Use Leading Conditions Measures related to Leading Conditions which would enable the creation of a longitudinal dashboard that follows patient progress, including medications, diagnostics, proven care, readmissions, functional status, and patient education Leading Conditions Efficiency Including Underuse and Overuse

8. 8 Sub-DomainMeasure Concepts Person-Centered Better Care Measures that show impacts to patients as they move through the entire care delivery system in an efficient manner. Readmission Value-Based Population and Preventive Health Measures focused on effective use of preventative health measures Immunizations Oncology Appropriate Care Measures that focus on underused clinical tools or stinting of care Access to Care Palliative Care Efficiency Including Underuse and Overuse

9. The Patient Safety tiger team identified three priority sub-domains to focus their efforts. –Medication Safety—Measures that show the prevention and reporting of Adverse Drug Events (ADEs) and use of evidence based medicine. –Hospital Associated Events—Measures related to the prevention and reporting of Hospital Acquired Infections (HAIs) and Venous Thromboembolism (VTEs). –Falls—Measures related to the prevention and reporting of falls. 9 Patient Safety

10. 10 Sub-DomainMeasure Concepts Medication Safety Measures that show the prevention and reporting of Adverse Drug Events (ADEs) and use of evidence based medicine Documentation of adverse events Reporting of adverse events Reporting medication errors Bedside medication verification Using CDS for high risk medications Correct medication reconciliation for EPs as well as hospitals Hospital Associated Events Measures related to the prevention and reporting of Hospital Acquired Infections (HAIs) and Venous Thromboembolism (VTEs) Reporting of HAIs and VTE Utilizing CDS to increase number of patients at risk for VTE receiving VTE prophylaxis Utilizing CDS to reduce HAIs Falls Measures related to the prevention and reporting of falls Utilizing CDS to determine and alert providers to fall risk Measure the compliance of conducting falls assessments for high risk patients Reporting on the number of falls Patient Safety

11. The Patient and Family Engagement tiger team identified five priority sub- domains to focus their efforts. –Self-Management/Activation—Measures that show that the patient understands what their role is in their own care process and has the knowledge, skills and confidence to move forward in this role, including resources & support for self- management. –Honoring Patient Preferences and Shared-Decision Making—Measures that demonstrate that the patient has the knowledge, resources and confidence in making informed decisions about their care. Also includes the quality of decision making, connecting patients to resources, assessing patient preferences and whether the care that was delivered is in line with patients’ preferences. –Patient Health Outcomes—Measures that focus on optimizing three States (Disease/disability, Health Risk, and Functioning Health) at the individual patient level and/or population level. –Health Activities Coordination—Measures that show if a patient was connected to community resources. –Family/Caregiver Engagement—Measure that show that a patient’s family/caregiver was engaged in/during the other four sub-domains listed above. 11 Patient and Family Engagement

12. 12 Sub-DomainMeasure Concepts Self-Management/Activation Measures that show that the patient understands what their role is in their own care process and has the knowledge, skills and confidence to move forward in this role, including resources & support for self- management Patient Activation Resources and Support for Self-Management Self-Management and Patient Activation Outcomes of Activation Honoring Patient Preferences and Shared Decision Making Measures that demonstrate that the patient has the knowledge, resources and confidence in making informed decisions about their care. Also includes the quality of decision making, connecting patients to resources, assessing patient preferences and whether the care that was delivered is in line with patients’ preferences. Shared Decision Making and Patient Preferences Shared Decision Making, Patient Preferences and Patient Experience of Care Patient Preferences Patient and Family Engagement

13. 13 Sub-DomainMeasure Concepts Patient Health Outcomes Measures that focus on optimizing three States (Disease/disability, Health Risk, and Functioning Health) at the individual patient level and/or population level Patient Health Outcomes – Disease/Disability State Patient Health Outcomes – Functional Health State Patient Health Outcomes – Health Risk State Health Activities Coordination Measures that show if a patient was connected to community resources Was the patient connected to community resources Family/Caregiver Engagement Measure that show that a patient’s family/caregiver was engaged in/during the other four sub-domains Patient/Family Engagement should be represented in all sub-domains Family/Caregiver Engagement should be represented in all sub-domains Patient and Family Engagement

14. The Population and Public Health tiger team identified three priority sub- domains to focus their efforts. –Healthy Lifestyle Behaviors—Longitudinal outcome measures of improvement (or lack of improvement) resulting from patient health-related behaviors. –Effective Preventive Services—Longitudinal outcome measures of improvement (or lack of improvement) resulting from the use of preventive health care. –Health Equity—Longitudinal outcome measures that evaluate the quality of health care across priority populations to track and prevent inequities and health care disparities. 14 Population and Public Health

15. 15 Sub-DomainMeasure Concepts Healthy Lifestyle Behaviors Longitudinal outcome measures of improvement (or lack of improvement) resulting from patient health-related behaviors Smoking Cessation BMI Alcohol Use Effective Preventive Services Longitudinal outcome measures of improvement (or lack of improvement) resulting from the use of preventive health care. Blood Pressure Diabetes Mental Health Health Equity Longitudinal outcome measures that evaluate the quality of health care across priority populations to track and prevent inequities and health care disparities. Healthy Lifestyles Care Access Insurance Population and Public Health

16. The Methodological Issues tiger team will focus on the following three areas: –Longitudinal measures –Delta measures –Adverse event reporting 16 Methodological Issues

17. Tiger Teams report to Quality Measures Workgroup (October 28, 2010) Quality Measures Workgroup presents recommendation to HIT Policy Committee (December) Send Request for Information (RFI) to identify measures in use or measures that need retooling that meet priorities and fill gaps (early November) Develop RFP for innovative measure development, testing, and validation to fill in gaps (mid-December) 17 Next Steps