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Move to Refine Quality Measures Gaining Momentum

By Tinker Ready  
   April 07, 2016

Complaints about quality measures are as abundant as the measures themselves. But some doctors are doing something about it. They're working to identify metrics that are "realistic and actually will have an impact on patient care."

Call it pushback, validation, or measurement science. The revolt against the volume and usefulness of outcomes measures continues.  

The AHRQ alone lists 1,280 quality measures on its site.

Efforts are underway to both challenge and refine existing guidelines and requirements. And, wonks take note, providers and patients are on the job, too.

One example: The emergency department at Beth Israel Deaconess Medical Center in Boston's Longwood cluster of hospitals sees more than 50,000 patients a year. Every time a patient undergoes procedural sedation in the ED, doctors there follow up with a formal quality assurance review.

Their analyses are designed to meet a Joint Commission standard that requires monitoring and evaluation of such cases, which carry the risk that comes with sedation.

Now team, including BIDMC emergency physician Jonathan Edlow, MD, has decided to examine the utility of the review. "We are trying to find out what metrics make sense and what don't," he told me. 

In a March paper in The Journal of Emergency Medicine, Edlow and his team reported that the review "offers little advantage over existing quality assurance markers." They concluded that review of high risk cases "may be useful."

Like other specialists, doctors in the field of emergency medicine are trying to become more active in the creation of quality metrics, Edlow says. They are looking for "measures that are realistic and actually will have an impact on patient care, as opposed to a lot of those [that] regulatory agencies come up with in the absences of physician input."  

David W. Baker, MD, vice present for healthcare quality evaluation at The Joint Commission, said that the study is based on an erroneous assumption. The Joint Commission does not require review of all cases that used procedural sedation.  The current standard says that hospitals should collect data to identify adverse events related to moderate or deep sedation or anesthesia. Baker said, “These reviews should be all about identifying opportunities to improve safety, and that’s exactly what occurred in the study.”  

Baker co-authored an article in the current issue of the Journal of General Internal Medicine with Cheryl Damberg of the Rand Corporation, entitled "Improving the Quality of Quality Measurement."

The piece noted that:" All clinical specialties should define the outcomes they are working to improve for acute, chronic, and palliative care, and should develop systems to measure those outcomes."

The Joint Commission welcomes input from those testing their standards, Baker says. The two sedation-related errors identified in the study involved airway management, so BIDMC may want to look more closely in that direction, he adds.

They already do. Physician errors in airway management are already automatically reviewed by the hospital's QA committee. This brings up another complaint about measures: They can be duplicative.
"There is a tremendous amount of concern about too many measure and too many different measures, "Baker told me. "Everyone in the measurement arena has heard that loud and clear and shares those concerns."  

He says the CMS/AHIP core measure are a step in the right direction. The Commission's measures are also aligned with CMS, he says, but hospitals are often required to report different measures to different payers and regulators.

Tinker Ready is a contributing writer at HealthLeaders Media.

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