Quality best when patients at center


Health reform’s connected goals of improved quality and increased efficiency are facing some roadblocks in the actual reporting of quality measures, the CEO of the National Quality Forum (NQF) told the Senate Finance Committee on June 26.

Christine Cassel, MD, a geriatrician and the new CEO of the NQF, told the same committee that birthed the Affordable Care Act that despite some notable progress in healthcare quality, “the nation has not come as fast or as far as expected.”

There may be something of a lag between digital health record adoption and digital quality reporting, Cassel said. While a majority of physicians and hospitals are now wired with EHRs, “this has not yet translated into accurate electronic capture and reporting of performance results as part of the care process,” she said.

Only about 10 percent of measures submitted for endorsement by the NQF are digital measures or specified for digital use. Some providers are also having trouble generating quality data for population health measurement with existing software, Cassel said, pointing to a recent Annals of Internal Medicine study that found 41 percent of surveyed doctors unable to generate quality metrics with their EHRs, as of early 2012.

Those issues should be a priority for fixing, because digital clinical data should offer a ripe opportunity for tracking quality trends on the macro level and nipping problems in the bud at the micro level.

Campaigns aimed at preventing hospital-acquired infections, through practices like hand-washing awareness, have showed some positive results among providers who have adopted them. Those strategies “should be replicated for other pressing problems,” Cassel said. “These campaigns should also include a focus on training in quality measurement science, culture change and work redesign.”

Another roadblock, though, is a lack of consensus on quality, Cassel said — and at the same time, there is the adage about “too much of a good thing” applying to healthcare.

“A lack of alignment across sectors, has produced a tsunami of quality reporting requirements,” Cassel said.

“Despite efforts to align across stakeholders, hospitals and physicians still face requests for reporting of look-alike measures and are inundated with requests for data. More must be done to find consensus among sectors on which measures should be used to improve care,” Cassel told the committee.

Key to alleviating regulatory burdens on providers while ultimately improving quality is “figuring out how to really assess value,” Cassel said.

To a large extent, value is increasingly becoming a function of patient experience — a goal in part being pursued through new healthcare payment and delivery models and patient-facing technologies linking them to clinicians.

“Our healthcare system is still more provider-centered than patient-centered, and our measures reflect as much,” Cassel said. “To turn in a new direction, we need more emphasis on assessments of patient experience of care and self-reporting of health status and functioning.”

Leaders from CMS, the ONC and AHRQ made similar arguments in calling for a new framework for federal healthcare quality measurements recently. The NQF and CMS recently launched a measures application partnership to identify the next generation of measures and align measurement across the public and private sectors.