AQA Invitational Meeting Summary
Report of the Measure Harmonization Workgroup
Janet Corrigan, National Quality Forum
Janet Corrigan, who chairs the measure harmonization workgroup, noted that
there were a number of measures in need of harmonization. As an example hospital-level
measures often look at a particular aspect of care, and this might be specified
very differently at the physician level. She also noted that there were many
measures from specialty societies (e.g., smoking cessation) that vary by
disease entity.
The workgroup's goal, said Corrigan, is to make measures valid across settings
(and to roll up and roll down). The workgroup also intends to review physician
and hospital measures in use and under development and align them where needed.
She noted that there are also some measures that will need to be harmonized
eventually, and that the workgroup is setting out a timeframe for accomplishing
this.
Corrigan said that the workgroup also intends to address overarching harmonization
issues. She noted that it is much easier to harmonize a measure during development
than after it has been developed and implemented. For example, she said,
there are currently no conventions on upper and lower age limits or standard
age bands.
Corrigan stressed that her workgroup is open to anyone who would like to
join and that she is hoping for the extensive involvement of major measure
developers. To organize its activities, the workgroup has formed eight focused
review teams (depression, coronary artery disease, prevention, asthma, smoking
cessation, cardiac surgery and surgical care improvement/ perioperative care,
acute myocardial infarction and heart failure, and venous thromboembolism).
The workgroup also is making plans to address other areas in the next couple
of years.
We want to harmonize where possible, said Corrigan, and see what other
options are available (e.g., to get changes in measures) where harmonization
is not possible. She stressed that one reason harmonization is important
is that standardizing certain processes is essential for developing electronic
health records. Finally, Corrigan indicated that the workgroup hopes to wrap
up most of its work by the end of this calendar year.
Discussion
Following Corrigan's remarks, one participant asked whether her workgroup
was looking at harmonizing measures across the physician/hospital domain
or describing a harmonization for measures within each domain. Corrigan replied
that the workgroup is looking at both.
The participant then asked what the relationship is between harmonization
within the physician measurements and what the AQA is doing. Can the participant
envision a decision tree where the measures are harmonized and delivered
to the AQA's workgroup on performance measurement? He expressed concern that,
rather than streamlining measure development and approval, more processes
were being set up.
Corrigan replied that her workgroup was trying to coordinate across the
specialty groups to make sure that measures are harmonized. Many of these
measures have already moved through the AQA, are before the National Quality
Forum, or have already been endorsed, she said. It depends on where the measures
are in the process.
The current process involves putting out brushfires, Corrigan continued.
To the extent that we can get measures consistent it will make it much easier
to incorporate electronic health records and get to quality improvement.
Our work will not slow down the process, she pledged. We are only trying
to make midcourse corrections and improvements where we can.
A different participant raised the issue of having the measure harmonization
workgroup review the multiple Web sites that are recording measures. Their
specifications are different, he said, and it is often not clear where a
measure is in the process (and, if endorsed, by whom). Irrespective of harmonization
efforts, he said, we need these Web sites to speak the same language.
Corrigan agreed, and added that she would like to see one consolidator
for every measure, and to have that site also catalogue and maintain an audit
trail that shows every change that has been made to a measure over time.
This is not, however, an inexpensive process, she cautioned.
One participant cited the perioperative measures and said that there are
differences between what has come out of the hospital level and the physician
level. It is important that we do not lose key components of either, she
said.
In response, Corrigan explained that when a measure needs to be harmonized,
the focus review team will come up with what it thinks are the appropriate
solutions. At that point, the review team will go back to the developers
and ask if they will agree that harmonization is needed and that the proposed
solution makes sense. She added that this overall process will take a number
of years so that people will have to live for now with some discordant measures.
It is not a perfect world, said Corrigan, but it is better than the one we
are in.
Another participant commented that even when there are harmonized measures
ready to be implemented (i.e., in a pilot project), that process cannot take
place until a whole set of additional specifications that deal with implementation
of that measure in that particular setting are developed. She cited, as examples,
sample size and how to attribute a measure to a given physician or practice.
One participant asked about the efficiency/episodes of care workgroup.
Will harmonization tackle efficiency as well? Corrigan noted that when the
conversation moves to episodes of care, the lack of harmonization across
measures is increasingly apparent. She added that it would be helpful to
start to work on this sooner rather than later in the development process
in order to create a framework around episodes of care. We realize we have
to live with a lack of harmony in some areas, said Corrigan, but we want
to develop a solid timetable to address these issues. She added that the
ideal time to catch and address these problems is when measures are under
consideration or in the early stages of development.
Regarding the problem of actually measuring the measures, one participant
remarked that for many today there is no way to do it. He noted that there
are no specifications to harmonize and no data yet to aggregate. He stressed
the need to capture data faster and better.
Final Remarks
Closing the meeting, Carolyn Clancy thanked everyone for participating and
reiterated that the AQA has accomplished much over the past 2 years. At the
same time, she said, there is a lot left to do, including addressing issues
of competence, cost of care, and harmonization. This is not easy stuff, she
said, but the alternative is to allow someone else to write the script for
us.
The next AQA meeting is scheduled for January 22, 2007, at the Capitol
Hilton.
Current as of December 2006
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Internet Citation:
AQA Invitational Meeting, October 24, 2006. Summary. December 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/performance5/
540 Gaither Road Rockville, MD 20850