Performance Measure
Specific, quantifiable indicator of an aspect of healthcare Proportion of patients treated according to a specified standard
Structures, processes, outcomes
Important for healthcare quality assessment
Increasingly important for reimbursement
Donabedian A. 1966; Donabedian A. 1988
Pay for PerformanceFacilities and Institutions
*Hospitals must participate in data collection, submission and public reporting of performance rates in order to receive the
annual payment update on Hospital Outpatient Prospective Payment System (HOPPS) services the following year.
Measures Development
May be designed by anyone: individuals, groups, institutions, or consortia
Most radiology-related measures developed by the ACR Metrics Committee, in collaboration with the AMA-PCPI
Identify areas of need
Review evidence
Construct measure specifications
Conduct public review
ExamplePQRS Measure #195 (NQF 0507)
Stenosis Measurement in Carotid Imaging Reports
Denominator: all finalized carotid imaging study reports Neck MRA, neck CTA, neck duplex ultrasound, carotid
angiography
Numerator: subset of finalized carotid imaging study reports that make direct or indirect reference to measurements of distal internal carotid diameter as the diameter for stenosis measurement To fulfill numerator criteria, measurements must make reference
to established and validated measurement criteria, e.g. NASCET
Measure Testing
Validity: does the measure capture what it intends to capture?
Reliability: do different raters obtain similar numerators and denominators?
Feasibility: is it challenging to implement?
Unintended consequences
AMA-PCPI
NQF Endorsement
Measure may go to the NQF for endorsement
Endorsed measures are considered “gold standard measures
Additional level of analysis, consensus development, and feedback Eight steps
Endorsed measures often end up in pay-for-performance programs Approximately 700 NQF-endorsed
measures
Post-Implementation Testing and
Maintenance
May be designed by individuals, groups, institutions, consortia
May be designed for internal quality improvement efforts or towards more widespread implementation (e.g. requiring NQF endorsement)
NQF measures undergo periodic maintenance and review Ensure relevance and continued best practices
New specifications (e.g. imaging modality) may be added
Harmonization
Measure steward is responsible for submitting updated information
ExamplePQRS Measure #10
Documenting the presence or absence of stroke, hemorrhage, or mass on brain CT and MRI reports
Retired by the NQF at the end of 2012
Lack of evidence supporting whether actual documentation of these findings affected outcomes or would change practice
t-PA often administered long before report finalized
NQF
Future Steps
Evidence on pay-for-performance has been mixed
Few imaging-related measures assess outcomes e.g., rate of diagnostic errors
Need for more outcomes-oriented measures
Difficult to develop radiology-specific outcomes measures as image performance and interpretation is only one component of a patient’s overall outcome
Ryan AM 2011; Ryan AM 2012; Jha AK 2012; Sutton M 2012
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