WASHINGTON, D.C. -- To fill gaps in assessing clinician performance that can promote higher quality healthcare, the National Quality Forum (NQF) has endorsed 67 clinician-level consensus standards relating to cancer care, infectious diseases, perioperative care, and care provided by thousands of medical professionals who are not MDs, but provide critical services. NQF also endorsed four facility-level measures in surgery and anesthesia, 17 measures addressing prevention and management of stroke across the continuum of care, and three measures for influenza and pneumococcal immunizations, a total of 91 consensus standards.
NQF-endorsed voluntary consensus standards are widely viewed as the “gold standard” for the measurement of healthcare quality.
“A commitment to public reporting and transparency can make the real difference in improving safety, healthcare quality, and patient engagement,” said NQF president and CEO Dr. Janet Corrigan. “This important set of measures can help us track progress toward improved safety and coordination of care across clinicians and settings.”
NQF has not previously addressed the area of infectious disease, particularly hepatitis and HIV/AIDs. The NQF portfolio already includes facility-level cancer and perioperative care measures, which are expanded and enriched by this new clinician-level measure set.
The purpose of NQF-endorsed voluntary consensus standards is to improve the quality of health care—through accountability and public reporting—by standardizing quality measurement in all care settings.
The 23 new NQF-endorsed voluntary consensus standards for infectious disease prevention, treatment, and management fill an urgent need within the current landscape of quality measures. Hepatitis C (HVC)-associated chronic liver disease is the most frequent indication for liver transplantation among adults in the United States. A study of Asian American adults found 10.7 percent of those born in Southeast Asia or the Pacific Islands were chronically infected with hepatitis B (HVB), and up to two-thirds were unaware they were infected.
With at least 4 million people infected with HVC and an estimated 1.1 million living with HIV/AIDS, these diseases, along with HVB, are major health challenges for the nation. Patients require complex and coordinated care, made more challenging because many have additional complicated conditions.
Cindy Weinbaum, MD, MPH, team leader at the Prevention Research and Evaluation Division of Viral Hepatitis, Centers for Disease Control & Prevention, and Fred Rachman, MD, chief executive officer and chief medical officer at the Alliance of Chicago Community Health Services, co-chaired NQF’s steering committee on clinician-level infectious diseases.
"Given the known gaps and variations in care for patients infected with HIV/AIDS and hepatitis B and C, it is imperative that the medical community begin to systematically measure itself at the individual clinician- and system-level to identify where improvement efforts are needed,” said Rachman. “The NQF process is instrumental for endorsing a single set of consensus standards that will help alleviate the multiple, competing sets of measures for HIV/AIDS and hepatitis against which clinicians are currently measured. This supports our ultimate aim – a uniform standard of care that every consumer can expect."
Measures were developed by the American Medical Association’s Physician Consortium for Performance Improvement, the AsianLiverCenter at StanfordUniversity, and the National Committee for Quality Assurance.
Seventeen new NQF-endorsed voluntary consensus standards include clinician-level and facility-level performance measures for critical care and anesthesiology; perioperative management; and general thoracic surgery. Additionally, prophylactic antibiotic measures previously endorsed by NQF were updated to include foot and ankle procedures.
Darrell Campell, MD, professor of surgery and chief of staff at University of Michigan Hospitals and HealthCenters, and Rome Walker, MD, medical director at Anthem Blue Cross Blue Shield in Virginia, co-chaired NQF’s perioperative care steering committee.
“All stakeholders, including employers, physicians and the government, are looking for endorsed standards like these perioperative performance measures that are feasible, reliable, and valid,” said Walker. “NQF is recognized as the principal body in the United States for the endorsement of healthcare performance and quality measures. The newly endorsed perioperative performance measures on a clinical level will be the driving force for improvement in both processes and health outcomes for patients.”
The standards measure the quality, efficiency, and care coordination of surgical care, including pre-operative, intra-operative and post-operative care within the surgical facility, as well as coordination with appropriate external providers. This includes perioperative temperature management for surgery patients and post-operative urinary catheter removal. There was a significant effort to ensure the facility-level standards were harmonized with the clinician-level perioperative standards.
Measures were developed by the Agency for Healthcare Research and Quality, the American Medical Association’s Physician Consortium for Performance Improvement, the Centers for Medicare & Medicaid Services, LifeScan, the National Committee for Quality Assurance, the Society of Thoracic Surgeons, the Society for Vascular Surgery, and the Vascular Study Group of Northern New England.
This set of three NQF-endorsed voluntary consensus standards aims to measure influenza and pneumococcal vaccination coverage among nursing home residents and influenza vaccination of healthcare personnel and brings measurement of vaccination practices in line with national guidelines. The endorsement of these measures broke new ground for NQF because the explicit focus was on measure harmonization based on standard measure specifications for flu and pneumococcal immunizations consistent with national guidelines.
Roger Baxter, MD, co-director of the VaccineStudyCenter at Kaiser Permanente in California, and Jane R. Zucker, MD, assistant commissioner at the New York City Health Department, co-chaired NQF’s influenza and pneumococcal immunizations steering committee.
“The harmonization of measures achieved by the NQF committee will hopefully result in a more clear understanding of the utilization of these important vaccines,” said Baxter.
“Setting standards for how we measure vaccination rates will help us raise the bar,” said Zucker. “Not only will we know how many people are accepting vaccinations, but also how many are refusing them. This way we can improve our strategies for vaccination, set targets for improving rates, and measure our success. In addition, the new health care worker standard is an important first step to increasing vaccination rates in this group, which would reduce the spread of influenza in health care settings.”
Measures were developed by the Centers for Disease Control & Prevention and the Centers for Medicare & Medicaid Services.
This work was conducted under a contract from the Centers for Medicare & Medicaid Services.
Visit www.qualityforum.org to read the full specifications for all of the new NQF-endorsed voluntary consensus standards and read NQF’s research recommendations.