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– PERFORMANCE MEASURES –
National Quality Forum (NQF)

logo for National Quality ForumPresident Clinton established the Advisory Commission on Consumer Protection and Quality in the Health Care Industry and convened the 32 member commision in 1997. In March 1998, the Commision report, "Quality First: Better Health Care for All Americans" was delivered to the President, calling for the creation of a "Forum for Health Care Quality Measurement and Reporting." In May 1999, the National Quality Forum was chartered as a public/private membership organizations whose mission was

"to improve American healthcare through endorsement of consensus-based national standards for measurement and public reporting of healthcare performance data."

The NQF is represented by health care consumers, purchasers, providers, health plans, experts in health services research, representatives from CMS and AHRQ, and other stakeholders. In addition to a 32-member Board of Directors, the NQF also has convened a standing panel of leading experts in quality improvement and measurement to identify the principles and priorities to guide a national measurement and reporting strategy.

The NQF does not develop performance measures, but leaves that work to the myriad of public and private quality improvement organizations that include CMS, AHRQ, JCAHO, NCQA, etc. Building upon their work, the NQF congregates groups of experts to scrutinize and endorse quality measures for national use. Performance measures that are employed across the national scope of healthcare increasingly require the endorsement of the NQF. The NQF also promotes the use of quality information and develops a research agenda to advance quality improvement.

In 2006, the NQF has endorsed more than 200 consensus standards. The following is a partial list of NQF publications endorsing performance measure sets. The complete list of individual performance measures through 2005, are available in the Compendium: 2000-2005.

NQF 2000-2005 Activities and Consensus Standards Projects

Performance Meaure /
Topic of Report
Description Links to PDFs
Release Measures
1.
Safe Practices for Better Healthcare
This report was one of the first reports release by the NQF. It details 30 healthcare safe practices that should be universally utilized in applicable clinical care settings to reduce the risk of harm to patients. In August 2005, the NQF began a review of the practices, seeking recommended additions or changes. A report was released on May 10, 2006 for comments and approval.
10/07/02


08/10/05
X


X
2.
Serious Reportable Events in Healthcare – A Consensus Report
The NQF initially release its list of "never events" as 27 adverse events that are serious, largely preventable, and of concern to both the public and healthcare providers for the purpose of public accountability. A Serious Reportable Events Consensus Standards Maintenance Committee (CSMC) was convened in May 2005 and has recommended updating 6 of the 27 events and expanding the list to include one new event related to artificial insemination. These revisions await endorsement by the NQF in mid-2006.
03/22/02


05/09/06
X


3.
National Voluntary Consensus Standards for Hospital Care
With contributions from multiple sources, the NQF in 2002 initially approved 31 hospital care measures confined to 6 care areas. This first group of hospital standards was rapidly followed in 2003 by endorsement of 8 additional measures, bringing the total to 39. A 2005-2006 update endorsed 3 additional measures, bringing the total to 42 measures across eight condition-specific high-volume priority areas of inpatient care. The 2006 updates also included the 3-Item Care Transition Measure (CTM-3) that provides patient-centered survey measure perspective on coordination of hospital discharge care. CMS publicly reports data from these measures for over 6,000 Medicare certified hospitals on its Hospital Compare web site.
10/18/02


10/03/03


07/07/06
X


X


X
4.
National Voluntary Consensus Standards for Adult Diabetes Care
The NQF in 2002 endorsed a total of 37 measures from the National Diabetes Quality Improvement Alliance, including 8 NCQA and CMS Accountability measures for use in developing report cards of managed healthcare plans and 29 Quality Improvement measures for performance assessment of healthcare professionals and healthplans. In 2005, the NQF revised the measures of diabetes quality of care. 9 measures for public reporting at the ambulatory provider/health plan level, 26 measures for internal quality improvement, and 3 community-level measures replace in full NQF's previously endorsed set of diabetes care performance measures. The diabetes care project was assimilated into phase III of the Ambulatory Care project.
10/01/02


10/11/05
X


X
5.
National Voluntary Consensus Standards for Ambulatory Care

In Phase I of the expedited ambulatory care process, an NQF workshop identified 10 priority areas for which standardized performance measures should be sought, including: patient experience with care, coordination of care, asthma, prevention (primary and secondary, including immunization), medication management, heart disease, diabetes, hypertension, depression, and obesity. The initial offering in Phase II was endorsement in August 2005 of 36 "physician-focused" performance measures and 3 recommendations. A 2005 update to Phase II endorsed 6 more physician-focused measures. Together with 9 dedicated diabetic measures identified in a parallel project, a total of 51 ambulatory measures were endorsed. The 42 physician-focused measures are in 7 priority areas: Asthma/Respiratory Illness (5), Behavioral Health/Depression (3), osteoarthritis (2), Cardiac - CAD (11), Cardiac - Heart Failure (7), Hyptertension (2), prenatal care (2), and Prevention, Immunization, and Screening (10).

Phase III re-reviewed and considered all available measures in the 10 designated priority areas. On May 22, 2006, the NQF endorsed 37 ambulatory care consensus standards, including 19 that were endorsed in 2005 as well. Therefore, 42 physician-focused ambulatory measures endorsed in Phase II, 9 diabetes ambulatory measures, and 18 new ambulatory measures brought the total number of NQF-endorsed ambulatory measures in mid-2006 to 69. The priority areas of these 37 measures include: Asthma/Respiratory Illness (10), Hyptertension (3), Medication management (4), Obesity (2), Prevention – Tobacco Cessation (3), Prevention – General Prevention (2), Prevention – Screening (6), and Prevention – Immunization (7). The NQF also endorsed seven research recommendations and three other recommendations as part of this activity.

The program was supported by the Ambulatory Care Quality Alliance (AQA) and other groups using measures created by the AMA's Physician Performance Measure group, CMS' Doctor's Office Quality Project, and the NCQA.

08/04/05


2006


05/22/06
X


X


X
6.
National Voluntary Consensus Standards for Nursing-Sensitive Care: An Initial Performance Measure Set
These 15 measures from multiple sources including multiple Nursing trade organization include 8 patient-centered outcome measures, 3 nursing-centered intervention measures, and 4 system-centered measures.
09/05/04 X
7.
National Voluntary Consensus Standards for Home Health Care
The set of performance measures includes 15 measures that facilitate efforts to achieve higher levels of patient safety and better outcomes for patients. CMS publicly reports data from these measures for nearly 7,000 Medicare certified home health care agencies on its Home Health Compare web site.
10/26/05 X
8.
National Voluntary Consensus Standards for Nursing Home Care
The report details 16 performance measures to facilitate standardized comparison of the quality of nursing homes. These quality measures were reviewed and endorsed by a diverse group of stakeholders. CMS is collecting and publicly reporting information on the quality of nearly 17,000 nursing homes as part of the Nursing Home Quality Initiative, which is based on the NQF-endorsed measures.
04/29/04 X
9.
National Voluntary Consensus Standards for Cardiac Surgery
21 measures for adult cardiac surgery from multiple sources, including the Society of Thoracic Surgeons
10/08/04 X
10.
National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism (VTE)
The NQF endorsed 20 performance measures, built upon Safe Practices 17/18, endorsing consensus standards for deep venous thrombosis, venous thrombo-embolism (DVT/VTE), and pulmonary embolism prevention and care.
05/18/06
11.
National Voluntary Consensus Standards for Reporting of Healthcare-associated Infection Data
The NQF is currently addressing measures for Healthcare Associated Infection (HAI). The call for measures was due on March 17, 2006. Endorsement of measures is pending in mid-2006.
11/17/05
12.
Standardizing Quality Measures for Cancer Care
This project intends to identify, evaluate, and endorse national voluntary consensus standards for cancer care quality measures and a framework for reporting them, concentrating initially upon voluntary consensus standards for quality of care in breast cancer, colorectal cancer, and end-of-life care. The latter measures were released for review on January 12, 2006, and the breast and colorectal measures are likely to be available for consideration in the latter part of 2006 or early 2007.
08/04 X
13.
Consumer Focused Measures of Mammography Center Quality
This project, funded entirely by the Robert Woods Johnson Foundation, evaluated consumer-focused measures of mammography. It is not a consensus project.
11/25/02
14.
All NQF-Endorsed Consensus Standards – Compendium 2000-2005
For the period of 2000-2005, the NQF completed 11 consensus projects focused on the endorsement of performance measures, serious reportable events, and safe practices; 4 projects resulted in NQF-endorsed frameworks, priorities, and a patient safety taxonomy.
05/16/06 X
15.
Standardizing a Patient Safety Taxonomy
This NQF report presents the first iteration of a taxonomy / classification system for healthcare errors and other patient safety problems. The NQF endorsed this taxonomy – thereby conveying to it the special legal standing of a voluntary consensus standard – with the understanding that much future work is required to improve it and make it more inclusive. The taxonomy is not a reporting system, but rather a template for organization and classification of patient safety information. It is not intended to replace existing taxonomies that already are in use. Instead, it is the NQF's intent that existing local taxonomies should be mapped to this taxonomy and should evolve to align with it.
02/13/06 X
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