AQA, HQA collaborate on national quality strategy
New committee to work closely with CMS, AHRQ
Two health care quality collaborative organizations, the AQA alliance and the Hospital Quality Alliance (HQA), have formed a new national Quality Alliance Steering Committee to better coordinate the promotion of quality measurement, transparency, and improvement in care.
Through the joint efforts of the AQA (an alliance of 135 physician organizations, consumers, employers, and health plan representatives that makes available quality information about physician care) and the HQA (a coalition of hospitals, nurses, physician organizations, accrediting agencies, government, consumers, and businesses that shares quality information about key aspects of hospital care), an increased amount of information on health care will be made available through the Internet.
The new steering committee will work closely with the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ), which are key members of both the AQA and HQA.
"The steering committee has come together to ensure that we better align the measurement of what we are doing, and to really think creatively about the kind of measurement that can best be done looking across the continuum of care," says Nancy Foster, vice president for quality and patient safety policy for the American Hospital Association. "There was a recognition by both organizations that if we didn't begin to have fruitful conversations, we would likely be at a place that caused confusion rather than focusing on quality improvement."
Foster offers the following example: "The AQA and the HQA have been looking at how to effectively measure quality of care for surgical patients. Obviously, as the patient experiences it, a surgery really starts with those initial decisions to go to surgery, and hopefully ends well with a follow-up that says 'The mission is complete and you are now back to health,'" she says. "The hospital piece of that is critically important, but it's obviously not the whole picture. We want to measure what happens before the actual operation takes place to ensure the best outcome during the operation, as well as determine if we got the outcome we desired. By coordinating our measurement activities, we think we will be able to give patients a better look across that entire continuum."
"First of all, I think it needs to be said that hospitals have collectively done great work over the last several years when it comes to public reporting," adds AHRQ Director Carolyn Clancy, MD. "We're excited that in 2007 this will include a measure of the patient's experience of care. The problem is that illness and the need for care do not necessarily stop when you leave the hospital, and in many cases, the reason why you're in the hospital is related to something outside of the hospital."
The new steering committee also will provide the opportunity to focus on patients' needs over an entire episode of illness, she continues. "Any aspect of care now being reported in terms of quality really depends on what happens before the patient comes to the hospital as well as after they are discharged," says Clancy. "If the hospital gives a beta-blocker or aspirin for a heart attack that's good, but the patient won't reap all the benefits unless they keep taking them when they go home."
More accurate measurement
Another byproduct of the new steering committee, says Clancy, is that it will make quality measurement more accurate and more efficient. "Right now, there is a huge investment of time and resources not only in identifying patients who are eligible for a particular measure, but also those who are not eligible," she observes. "A patient comes who you expect will get a beta-blocker, but information that there might be a contraindication resides in their outpatient chart. That either means the hospital gets unfairly 'dinged' or an enormous effort is expended to uncover that information — i.e., the patient has asthma."
One of the first things the new group will take on, she says, will be to make sure measures are consistent across settings. "Ultimately, we will be constructing measures for episodes of care where there is shared accountability for physicians in inpatient and outpatient practice," she explains.
"For quality managers, this means there will be less discord in the specific measures we use — the measures themselves should be broadly useful — and we may be able to take a look at some areas of quality that we couldn't have if we were looking just at hospitals or at physician practices," says Foster.
Pilot programs benefit
One of the first beneficiaries of the new alliance will be the six pilot programs announced by AQA in March. The projects are charged with the responsibility of identifying, collecting, and reporting data on the quality of physician performance across care settings.
"The HQA, of course, has a broad array of data up and available on 4,000 hospitals," notes Clancy. "The AQA was in a very different starting point; we did not have the same infrastructure to build off of."
The pilots, she continues, were initially intended to effect and publicly report on a set of measures that were physician-focused. "We're in the midst of discussions on how to broaden the work of those pilot projects," says Foster. "That will certainly be among the first tasks we undertake."
"We expect that in 2007, patients in these communities — and likely others who become pilots — will have access to public reports on selected aspects of physician performance and hospital performance," says Clancy.
Beyond that, Foster says, the steering committee will begin "mapping out a plan for other activities that can best be done together — a plan for how we stay connected, and as suggested, look at specific issues like the measurement of efficiency."
"The endgame here for both alliances is to get to uniformity in measures, so they do not become ends in themselves but a means to the end of improving care and giving people good information on which they can make their health care decisions," Clancy concludes.
For more information, contact:
Nancy Foster, Vice President for Quality and Patient Safety Policy, American Hospital Association, 325 Seventh Street, N.W., Washington, DC. Phone: (202) 638-1100.
Carolyn Clancy, MD, Director, Agency for Healthcare Research and Quality, 540 Gaither Road, Suite 2000, Rockville, MD 20850. Internet: www.ahrq.gov.
Two health care quality collaborative organizations, the AQA alliance and the Hospital Quality Alliance (HQA), have formed a new national Quality Alliance Steering Committee to better coordinate the promotion of quality measurement, transparency, and improvement in care.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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