What are the key Industry QI Initiatives?
National Quality Forum (NQF)
The National Quality Forum (NQF) is a not-for-profit organization that aims to improve the quality of healthcare received by all Americans. NQF strives to develop a strategy for the health care quality measurement and reporting to improve the quality of the American Healthcare system as a whole. NQF has a three-part mission to address quality improvement.
NQF was created in 1999, and receives both public and private funds, with the Robert Wood Johnson Foundation and CMS providing much support in recent years. Membership in NQF includes consumer organizations, public and private purchasers, physicians, nurses, hospitals, accrediting and certifying bodies, supporting industries, and healthcare research and quality improvement organizations.
Because of its vast array of members, NQF has influence on all types of providers. Specifically, The National Association of Public Hospitals and Health Systems (NAPH) is a member organization that focuses on safety net hospitals. NAPH strives to bring the concerns of these hospitals to the table, and to ensure that they are included in NQF’s goals and programs.
The wide variety of stakeholders included in NQF allows it to remain in a position to influence policy and continue to achieve its mission.
Hospital Quality Alliance (HQA)
The Hospital Quality Alliance (HQA) is a national collaboration consisting of public and private organizations. The collaboration strives to improve quality standards at hospitals nationwide by making important information about hospitals available to the public.
The HQA utilizes quality measures endorsed by the National Quality Forum to implement standardized reporting of measures across all evaluated hospitals. A key part of the HQA is Hospital Compare, a website that reports on performance information on over 4,000 hospitals nationwide. Hospital Compare includes public, private and safety net providers. Reports on Hospital Compare are updated quarterly. HQA and Hospital Compare report on specific indicators and measures, including the use of EHRs at hospitals. Recent data gather from HQA has shown moderate improvements in quality or care by providers who have implemented EHRs.
National Committee for Quality Assurance (NCQA)
The National Committee for Quality Assurance (NCQA) is a not-for-profit organization that evaluates health care quality of primarily health maintenance organizations (HMOs). It was started in 1990, with a mission to “improve the quality of health care”. The organization’s overall vision is to “transform health care through measurement, transparency and accountability”.
The NCQA develops and implements standards, measures and reports on health care quality. Its measures have become the standards by which office practices are evaluated for pay-for-performance programs, and are now utilized by the American Board of Internal Medicine in the recertification process for its members. It has helped to reach a consensus about quality improvement issues, including health IT and EHR implementation and measures by working with a variety of stakeholders in the medical field.
One of NCQA’s key programs is Health Plan Employer Data and Information Set (HEDIS). HEDIS is one of the oldest and best-known public reporting systems. It measures a growing number of technical processes of care, collected from both administrative data and medical record review. Health plans participate voluntarily and comparative quality information is posted on the NCQA’s Web site.
Improving Performance in Practice (IPIP)
Improving Performance in Practice (IPIP) is a state-based, nationally led quality improvement initiative largely funded by the Robert Wood Johnson Foundation. The program was started at the North Carolina Academy of Family Physicians and stems from collaboration among many primary care societies. The program’s focus is to improve the quality of care and outcomes for patients with chronic diseases in the physician office setting. IPIP providers physicians with tools such as disease registries, and stresses the importance of monthly data reporting and aggregate summaries to ensure the highest quality of care.
There are number of key features of IPIP, including the use of Quality Improvement Consultants (QICs). QIC’s work closely with physicians and other members of the health care team in the physician office and focus on five key areas that help practices provide better care for patients with chronic conditions: (1) Use a registry to identify patients with diabetes/asthma prior to the visit, (2) Use a condition-specific decision support tool (e.g., a visit planner), (3) Create a customized flow diagram and protocols to standardize the care process, (4) Conduct frequent monitoring of protocol use, (5) Educate patients in self-management and support their efforts.
Another key feature of IPIP is that it aims to align itself with other national QI initiatives to create a cohesive system. IPIP strives to have participating offices put themselves in positions to participate in pay-for-performance programs, as well as other QI Initiatives. Additionally, participation in the program helps physicians to complete requirements for their Maintenance of Certification.
Improving Performance in Practice Initiative - North Carolina AHEC
Improving Performance in Practice Program Initiative - Robert Wood Johnson Foundation
Bridges to Excellence (BTE)
Bridges to Excellence (BTE) is a national, not-for profit, pay-for-performance program that is implemented in the private sector. It was developed by employers, physicians, health care services, researches and other industry experts to meet the challenge set forth by the Institute of Medicine (IOM) in their 2001 report “Crossing the Quality Chasm” of redesigning payments for care to encourage providers to make positive changes to their care processes. The mission of BTE is to “create significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they have implemented comprehensive solutions in the management of patients and deliver safe, timely, effective, efficient, equitable and patient-centered care”.
The program has a standard data exchange platform and performance measures, but allows each region that chooses to implement BTE flexibility to tailor the program to its unique needs. BTE’s guiding principles are (1) Dedication to transforming care processes to reduce mistakes will require investments, for which purchasers should create incentives, (2) Significant reductions in defects (misuse, underuse, and overuse) will reduce the waste and inefficiencies in the health care system today and (3) increased accountability and quality improvements will be encouraged by the release of comparative provider performance data delivered to consumers in a compelling way to lead to better patient care.
The Institute for Healthcare Improvement (IHI)
The Institute for Healthcare Improvement (IHI) is a not-for-profit organization, started in 1991, aimed at improving health care quality around the world. The IHI works with healthcare professionals worldwide to accelerate progress towards achieving its six improvement aims for the health care system (1) safety, (2) effectiveness, (3) patient-centeredness, (4) timeliness, (5) efficiency and, (6) equity.
One of IHI’s largest programs, the Breakthrough Series QI Learning Collaborative Model has been used successfully in many health care settings. The Model for Improvement used in the Breakthrough Series is a QI model that includes four components (1) aims and goals; (2) performance measures, (3) strategies and ideas for changes, and (4) the use of plan-do-study-act (PDSA) cycles. The Breakthrough Series utilizes a structured, peer based learning approach that many institutions have used and adapted to reach quality improvement goals.
The Breakthrough Series has had many successes, one of which was a project which included 10 safety net providers in the Breakthrough Series Collaborative on Improving Care at the End of Life. It was found that safety net providers were able to achieve their goals proportionally to other hospitals and that in most selected areas of success and failure safety-net hospitals were similar to the other hospitals participating in the collaborative. In fact, although these hospitals were limited in resources, the safety-net teams had some opportunities that other hospitals did not have. IHI also recommends involving senior leaders in future endeavors such as this to enable teams to focus more energy and attention on goals.
Institute for Healthcare Improvement
Helping Safety-Net Providers Improve Care for Medicaid Patients at the End of Life – Robert Wood Johnson Foundation
Ambulatory Care Quality Alliance (AQA)
The Ambulatory Care Quality Alliance (AQA) was created in 2004 by a coalition of physician groups, consumer groups, health insurance groups and researchers to determine the most efficient way to improve performance measurement, data aggregation and reporting in the ambulatory care setting.
The mission of AQA is to “improve health care quality and patient safety through a collaborative process in which key stakeholders agree on a strategy for measuring performance at the physician level; collecting and aggregating data in the least burdensome way; and reporting meaningful information to consumers, physicians and other stakeholders to inform choices and improve outcomes”. AQA aims to create consensus on to improve quality of health care and has developed the following:
AQA continues to be a strong voice in the field. Support from CMS and stakeholders involved have helped it make progress on QI efforts.
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