1. QMWG Measures Framework June 8, 2011

2. Core + Categorized Menu

3. Alignment with National Quality Strategy NQS PrioritieseQM Domains Making care safer by reducing harm caused in the delivery of care. Patient Safety Ensuring that each person and family are engaged as partners in their care. Patient & Family Engagement Promoting effective communication and coordination of care. Care Coordination Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. Clinical Process Working with communities to promote wide use of best practices to enable healthy living. Population & Public Health Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models. Efficiency

4. Proposed Model Core is maintained and additional measures are added Menu is maintained and additional measures are added Menu measures are stratified into the 6 domain areas Providers pick measures from the core list Providers pick measures from the menu list – Providers pick 1 measure from each of the domain areas

5. Dr. James – Primary Care Physician Measure TitleMeasure StatusChosen Measure Hypertension: Blood Pressure Measurement MU Stage 1 ♦ Preventive Care and Screening Measure Pair: a. Tobacco Use AssessmentMU Stage 1 ♦ Preventive Care and Screening Measure Pair: b. Tobacco Cessation Intervention MU Stage 1 ♦ Weight Assessment and Counseling for Children and AdolescentsMU Stage 1 Childhood Immunization StatusMU Stage 1 Preventive Care and Screening: Influenza Immunization for Patients >= 50 Years Old MU Stage 1 Medication Reconciliation Recently Retooled ♦ Closing the Referral LoopTo be developed ♦

6. Dr. James – Primary Care Physician Measure Title Measure Status Specialty Area Patient & Family Engagem ent Clinical Process Care Coordina tion Patient Safety Populatio n & Public Health Efficiency Major Depressive Disorder (MDD): Suicide Risk Assessment Recently Retooled Internal Medicine Family Practice Psychiatry ♦ Asthma AssessmentMU Stage 1 Pulmonology Internal Medicine Pediatrics ♦ Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement MU Stage 1 Psychiatry Family Practice Internal Medicine ♦ Measure of medication monitoring for patients on chronic medications To be developed All Specialties ♦ Preventive Care and Screening: Influenza Immunization for Patients >= 50 Years Old MU Stage 1 Internal Medicine Family Practice Pulmonology Cardiology ♦ Low Back Pain: Use of Imaging Studies MU Stage 1 Internal Medicine Orthopedics Rheumatology ♦

7. Methodologic Issues Patient reported data--a vehicle is needed to capture data tagged to source (need CDA type standard and transport standard for self-reported race, ethnicity, language, and equity; perception of experience; and structured data for m-health/home devices) Delta measures—need guidance for reasonable measures of quality for comparison of data points over time Problem lists--identify standards to consistently represent attributes and that can be used for reconciliation Capacity and scalability of EHRs—must be in step with increasing complexity of quality measures Attribution of provider—needs standards to assign each member of a panel for measurement