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May 17, 2006

Consensus Development at National Level to Reduce Hospital Reporting Burdens and Enhance Measurement Development Process

In an effort to reduce the reporting burdens of hospitals to various national organizations on performance improvement data and information and to rapidly move the measurement development process along, the National Quality Forum and the Hospital Quality Alliance have undertaken some major initiatives. At the National Quality Forum (NQF) Spring Membership Meeting on May 16, these initiatives were announced to the NQF members and public.

The NQF is the national organization for ongoing review and approval of measurements that are used in public reporting and quality improvement. The Hospital Quality Alliance is the national organization implementing the hospital NQF approved national measurements.

National Quality Forum (NQF)
New Leadership at NQF. Janet Corrigan, Ph.D., M.B.A. assumed the leadership of the NQF in March when the National Committee For Quality Health Care (NCQHC) merged with NQF. Dr. Corrigan had been the President and CEO of NCQHC and assumed the position of President and CEO of the merged NQF and NCQHC.

Prior to joining NCQHC Dr. Corrigan was Senior Board Director at the Institute of Medicine (IOM) where she was responsible for the IOM Health Care Services portfolio of initiatives on quality and patient safety, including IOM’s "To Err Is Human" and "Crossing the Quality Chasm." Prior to joining IOM, Dr. Corrigan was the Executive Director of the President’s Advisory Commission on Consumer Protection and Quality In the Health Care Industry. Dr. Corrigan has served on various boards and committees including Robert Wood Johnson Foundation, Baldridge Board of Overseers, and others.

Dr. Corrigan brings a wealth of understanding and experience in advancing quality and performance measurement initiatives. Having worked on the President’s Commission and the IOM, she is working on developing a clear national vision of quality and public accountability among the various stakeholders.

2006 and 2007 Goals. Currently NQF does not have a schedule for measurements to be developed or reviewed and has had inconsistent patterns and approaches to consensus development. Starting this summer, NQF will have and communicate a clear vision on the measurement agenda and enhancing the measurement consensus development process. Discussion on areas for measurement development were explored and on May 15 members were engaged in a work group priority setting exercise.

Currently measurements submitted to NQF for review vary in their level of details and specifications and information needed for implementation. As a result, while a measurement may be approved for usage, there is often a lengthy lag time as the measurement requestor develops specifications for implementation. Information needed for implementation includes specifications on data collection, data attribution, methodologies, analysis, validation, uses, and access. NQF has termed this the role of the "Data Steward" and is considering whether to undertake this themselves or to contract this service to another party (parties).

NQF gets their financial support primarily from government contracts and organizations requesting measurement reviews and about forty percent of their income is from membership dues. Approximately 330 organizations belong to NQF representing national, state, and local providers, health professionals, health plans, purchasers, employers, consumers, researchers and federal agencies. In the next few months, NQF will be exploring various options to ensure a steady base of financial support including looking toward federal government support as suggested in one of the most recent IOM reports on quality improvement.

During the summer, NQF will undertake a variety of developments to improve communication with members and the public. Additionally, their web site is under reconstruction and is expected to be easier to use and navigate to locate information.

In 2007, NQF will be revisiting its mission, governance, stakeholder representation and other organizational areas. As there has been concern that membership voices are not being heard, NQF will explore other avenues for gaining membership input.

Proposed Measurements Under Review. There are many measurements at various stages of review at NQF. Measurements undergoing initial or supplemental review include:

As IHA is a member of NQF, IHA will keep you informed of developments and seek input on measurements as NQF makes them available for review and comment.

Hospital Quality Alliance (HQA)
The HQA is familiar to most hospitals as it is the organization that oversees the implementation and reporting of hospital performance measurements to populate the publicly available Hospital Compare website. The HQA is made up of national provider organizations including AHA, JCAHO, Federation, American College of Surgeons, etc. HQA also includes federal agencies and most recently invited commercial health plans and employers to join the HQA.

Hospital Registry or Repository. Nancy Foster, Vice President of the American Hospital Association and HQA member representative, announced that HQA has contracted with a consultant to assess alternative options for developing and implementing a hospital registry or repository. This registry would allow hospitals to submit a single set of data and under rules and with hospital permission, allow other stakeholders to access this information, such as the JCAHO. Additionally, HQA has retained another consultant to assist them in business and operational planning should they opt to proceed. While preliminary results may be available in early fall, a plan of action will be available in early 2007.

Reducing Provider Burden
The goals of these initiatives are to make meaningful information available to the public and at the same time reduce hospital reporting burdens by having one source of national measurements and specifications coupled with providers reporting to one national source.

While these are outstanding initiatives among stakeholders, there is still much more to do. As patients move along a continuum of care, there is still much to do to bridge gaps in measurements and information along the continuum.

Promoting Electronic Health Records
With all of these initiatives under development and an eye to the future of measuring patient care along a continuum, there is widespread support that electronic health records are key to fast tracking measurement implementation while allowing hospitals to participate in an efficient and effective manner. Both NQF and HQA have pledged their support to promoting and expanding electronic health records and to support the national initiatives underway by the federal government.

IHA will continue to keep you informed on these national developments that will directly affect your hospital. If you have questions or comments regarding the NQF or HQA, please contact Pat Merryweather: pmerryweather@ihastaff.org.