Becker's Clinical Quality & Infection Control

27 QUALITY IMPROVEMENT & MEASUREMENT NQF Publishes Guide to Reduce Variation in Quality Measures By Heather Punke A n analysis commissioned by the National Quality Forum identified 1,367 quality measures used by 48 state and regional programs — but only 509 of them were distinct. The more than 800 remaining measures overlapped or had similar focus but different variations in specifications. "Quality measures are essential blocks in large-scale pub- lic- and private-payer efforts to reform the nation's health- care system," said Helen Darling, the then-interim presi- dent and CEO of NQF. "But slightly different versions of the same measure contribute to waste through reporting burden for providers and make performance compari- sons more difficult." In December, NQF published a report — funded by HHS — focused on how to reduce the unintended varia- tion between quality measures. It was put together by a 16-member panel, which represented experts in measure development and implementation, health informaticists, provider groups, purchasers, payers and others who use reported measures. Here are four key points from the report. 1. The panel defined variation as "any deviation from a reference measure's specifications." 2. Variation often is related to data availability, measure complexity and communication, the panel concluded. 3. Therefore, according to the report, strategies to pre- vent variation are focused on access to measures, data collection strategies, implementation guidance, bench- marking against set standards, transparency regarding communication and collaboration through feedback loops and forums. 4. The report provides stakeholders with "a methodical approach to improve the comparability and interpretabil- ity of measure results, while reducing the burden of du- plicative measures." "We have an urgent need to focus on the measures that really matter for quality improvement," said Helen Burs- tin, MD, chief scientific officer with NQF. "To make care better for patients, in addition to reducing variations in measures, it's also important that we eliminate measures that are duplicative, ineffective or that have reached the limits of their usefulness." n Johns Hopkins Awarded Millions to Share Quality Methods With 750 Hospitals By Brian Zimmerman T he Johns Hopkins Armstrong Institute for Patient Safety and Quality in Balti- more has been awarded a federal con- tract potentially worth $16 million to educate providers at 750 hospitals across the nation on enhanced recovery aer surgery protocols. e program is funded by the U.S. Agency for Healthcare Research and Quality. e contract is slated to begin with an initial $4 million investment for the first year with three one-year options for renewal of $4 mil- lion each. e American College of Surgeons will collaborate in the effort and recruit the participating hospitals, according to e Bal- timore Sun. While the ERAS protocols have existed for years and are used widely in Europe, Johns Hopkins took a novel implementation ap- proach when the hospital adopted the pro- tocols in 2013. e hospital combined ERAS practices with AHRQ's Comprehensive Unit- Based Safety Program, which is a five-step culture change designed to engage frontline providers in the reduction of patient harm. e combination of both safety initiatives led to a 1.5-day length of stay reduction, a $1,500 cost reduction and a 50 percent decrease of surgical site infections among colorectal sur- gery patients. "With the success of ERAS at our hospital, we are excited to share this approach with other hospitals," said Michael Rosen, PhD, associ- ate professor in anesthesiology and critical care medicine with the Armstrong Institute, in a release. "is will be an important step in improving patient care throughout their surgery process." Improvement and research efforts at the 750 hospitals will initially focus on abdominal operations in colorectal surgery. In the future, the quality and safety improvement efforts will expand to areas like bariatric surgery, or- thopedic surgery, gynecology and emergency general surgery. "Too oen, patients suffer complications and prolonged hospitalizations aer surgery, al- though the steps to prevent these results are known," said Peter Pronovost, MD, PhD, di- rector of the Armstrong Institute and senior vice president of patient safety and quality at Johns Hopkins Medicine. "is program brings these recommended practices together into one coordinated, unified program where everyone — clinicians, patients and their loved ones — understand what they must do for the best possible outcome." n

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