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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/


 

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