1. NATIONAL CONSENSUS STANDARDS FOR PHYSICIAN PERFORMANCE: ROUND 1
Kenneth W. Kizer, M.D., M.P.H.
President and CEO
National Quality Forum
August 22, 2005

2. Presentation Overview
Provide some context for physician performance standards
Provide an overview of the NQF Ambulatory Care PM Project:
What has occurred to date?
What is forthcoming?

3. STANDARDS FOR PHYSICIAN
THE IDEA OF HAVING
STANDARDS FOR PHYSICIAN
PERFORMANCE IS NOT NEW

5. The Quest for Healthcare Quality
“If a physician make a large incision with the operating knife and cure it,…, he shall receive ten shekels in money.
If a physician make a large incision with the operating knife, and kill him,…, his hands shall be cut off.”
Code of Hammurabi, 1870 BC

6. TODAY’S INCREASED ATTENTION TO HEALTHCARE QUALITY IS BEING DRIVEN BY AN UNPRECEDENTED CONFLUENCE OF FORCES

7. Healthcare Quality Improvement Driving Forces
Knowledge of deficiencies
Rising healthcare expenditures
Purchaser activism
Consumerism
Regulation and accreditation

8. A CROWDED FIELD
Who are the “players” in the performance measurement and quality improvement game?

9. A partial list of the Alphabet Soup of PM/QI-Related Organizations
JCAHO NCQA CMS
IOM AHRQ FDA
NQF CDC QIOs
HQA GAO PCPI
OPM NBCH ACQA
Leapfrog MedPAC ACMQ IHI WBGH PBGH
QUIC UHC ABMS

10. Lots of Signals…..
BUT
Little Direction

11. There is need for a single national entity to be the steward for healthcare performance measurement and quality improvement.

12. NATIONAL QUALITY FORUM
The
NATIONAL QUALITY FORUM
(NQF)

13. NQF-ENDORSED CONSENSUS STANDARDS

14. NQF Consensus Development Process
Board of Directors,
NQF Staff & Management
Member Councils,
Non-member External Entities
Conceptualize and Plan Project
Appoint Steering Committee
and Technical Advisory Panels
NQF ( nominations
from membership and public)
Steering Committee
with NQF Staff
(any entity can propose
measures, etc., for
consideration
Identify (open call) and Evaluate
measures, etc.;
Propose candidate voluntary
consensus standard (VCS)
Review and Revise
Member Councils,
Member Organizations,
Public
Vote by Member Councils
Member Organizations
Approved by All
Member Councils
Review and Revision
of unapproved
VCS
Review and Revision
of unapproved
VCS
Member Councils,
Member Organizations,
Public
Repeat Vote
Approved by at least 2 Councils
Approved by 0 or 1 Council
(no further action)
Board of Directors Vote
Board of Directors
Appeals of Board-endorsed VCS
Members and Nonmembers
directly and materially affected
by VCS
NQF-Endorsed
Voluntary Consensus Standard

15. NQF National Consensus Standards: Patient Safety
Patient Safety Strategic Priorities (2001)
Serious Reportable Adverse Events (2002)
Safe Practices (2003)
Standardized Patient Safety Taxonomy (2005)
Improved Medication Use Recommendations (2005)
Improved Informed Consent Process (2005)

16. NQF National Consensus Standards: Institutions/Settings of Care
Acute Care Hospital National Performance Measures
Initial Set (2003)
Nursing Care PMs (2004)
Cardiac Surgery PMs (2004)
Coordination of Care PMs (2005)
Mortality for AMI, CHF and CAP (2005)
HCAPHS (2005)

17. NQF National Consensus Standards: Institutions/Settings of Care
Nursing Home Care Performance Measures (2002, 2004)
Home Care PMs (2005)
Palliative and Hospice Care Framework (2005)
Ambulatory Care ( )
Dialysis Centers/ESRD (2006)

18. NQF National Consensus Standards: Conditions/Populations
Diabetes (2002, 2005)
Cancer Care Quality Measures ( )
Deep Venous Thrombosis ( )
Child Healthcare PMs (?2006)
Behavioral Healthcare PMs ( )

19. NQF National Consensus Projects
National Priorities for Healthcare Quality Measurement and Reporting
15 Healthcare conditions priorities
5 Process of care priorities
2 Infrastructure priorities

20. NATIONAL CONSENSUS STANDARDS FOR AMBULATORY CARE

21. NQF National Consensus Standards: Ambulatory Care Project
Phase I (2004) – Identify priority areas
Phase II (2005) – Expedited consensus of existing ambulatory care PMs
Phase III ( ) – Flesh out all 12 priority areas; four cycles

22. National Consensus Standards for Ambulatory Care: Phase I - Priority Areas
Patient experience with care
Coordination of care
Asthma
Prevention, including immunization
Medication management
Ischemic heart disease
Diabetes
Hypertension
Depression
Obesity

23. National Consensus Standards for Ambulatory Care: Additional Priority Areas
Prenatal care
Bone conditions

24. National Consensus Standards for Ambulatory Care: Phase II
36 physician-focused PMs endorsed in seven priority areas (8/3/05)
6 measures will undergo a second round of voting
2 measures not endorsed will be re- considered in Phase 3

25. NQF-EndorsedTM Ambulatory Care Consensus Standards
Asthma/Respiratory Illness (4)
Behavioral Health/Depression (3)
Bone Conditions (2)
Heart Disease—CAD(10), CHF (7)
Hypertension (2)
Prenatal Care (2)
Prevention, Immunization, and Screening (6)

26. NQF-EndorsedTM Ambulatory Care Consensus Standards
Asthma/Respiratory Illness
Asthma assessment
Asthma: pharmacologic therapy
Appropriate treatment for children with upper respiratory infection
Appropriate testing for children with pharyngitis

27. NQF-EndorsedTM Ambulatory Care Consensus Standards
Behavioral Health/Depression
Optimal practitioner contacts for medication management
Effective acute phase treatment
Effective continuation phase treatment
Bone Conditions
Osteoarthritis: assessment for use of anti-inflammatory or analgesic over-the-counter medications
Osteoarthritis: functional and pain assessment

28. NQF-EndorsedTM Ambulatory Care Consensus Standards
Heart Disease—Coronary artery disease
Symptoms and activity
Cholesterol screen
Lipid profile
Drug therapy for lowering low-density lipoprotein (LDL) cholesterol
Cholesterol control
LDL cholesterol level
Anti-platelet therapy
Beta blocker therapy–prior myocardial infarction
ACEI/ARB therapy
Smoking cessation and smoking cessation intervention      

29. NQF-EndorsedTM Ambulatory Care Consensus Standards
Heart Disease—Congestive heart failure
Left ventricular function (LVF) assessment
Weight measurement
Assessment of clinical symptoms of volume overload
Assessment of activity level
Beta blocker therapy
ACEI/ARB therapy
Warfarin therapy for patients with atrial fibrillation

30. NQF-EndorsedTM Ambulatory Care Consensus Standards
Hypertension
Plan of care
Controlling high blood pressure
Prenatal Care
Anti D immune globulin
Screening for human immunodeficiency virus (HIV)

31. NQF-EndorsedTM Ambulatory Care Consensus Standards
Prevention, Immunization, and Screening
Tobacco use and tobacco cessation
Advising smokers to quit, discussing smoking cessation medication, and discussing smoking cessation strategies
Discussing urinary incontinence and receiving urinary incontinence treatment
Flu shot for older adults and flu shot for adults ages years
Influenza vaccination
Pneumonia vaccination
   

32. Phase II Measures in 2nd Round of Voting
Use of appropriate medications for people with asthma
Coronary artery disease: Beta-blocker treatment after a heart attack
Childhood immunization
Breast cancer screening
Colorectal cancer screening
Cervical cancer screening

33. National Consensus Standards for Ambulatory Care: Phase III
Cycle 1 (Fall 2005): care coordination, medication management, obesity, asthma, hypertension, prevention
Cycle 2 (Spring 2006): patient experience with care, heart disease, bone conditions, prenatal care, behavioral health, diabetes

34. National Consensus Standards for Ambulatory Care: Phase III
Cycle 3 ( ): special ambulatory settings of care (i.e., ambulatory surgical centers)
Cycle 4 ( ): development of index/composite measures

35. National Consensus Standards for Ambulatory Care: Project Deliverables
Sets of endorsed consensus standards
Recommendations for implementation and research issues for each set.
Commissioned background paper on barriers to small group (< 5), provider-level implementation
Index(es)/composite(s) for ambulatory care measurement and reporting.
Workshop to guide ambulatory care measurement research, development, and testing