Addressing the Gap in Feasible, Valid, and Important Quality Measures for the Treatment of Carpal Tunnel Syndrome

项目摘要/摘要 背景：衡量、报告和激励医疗保健质量的努力现在在 退伍军人健康管理局(VA)、联邦医疗保险和私人医疗保健设置-但很常见 包括腕管综合征(CTS)在内的肌肉骨骼疾病在这些努力中被省略，原因是 缺乏有效、可行的质量措施。尽管诊断和治疗的临床实践指南 CTS的管理近期陆续出台，这些指南没有有效可行的措施 目前存在。此外，医疗保健专业对开发和实施患者也非常感兴趣 已报告的基于结果衡量的质量衡量(PRO-QMS)。在实施过程或结果之前- 在质量测量的基础上，确定它们是否有效并产生可操作的信息是至关重要的。 意义/影响：弗吉尼亚州越来越多地成为社区医疗保健的购买者，使其 评估医疗质量指标对于退伍军人管理局和跨系统比较是否有效至关重要。这 建议与退伍军人事务部和HSR&D的优先事项保持一致，包括质量和安全，支持 制定基于价值的支付模式，监测非退伍军人购买的质量和安全 以及比较VA和非VA护理质量的评价措施和方法。接下来的 缺乏有效的CTS质量措施使所有利益相关者没有任何手段来确定质量差距， 评估质量改进计划的影响，或制定基于绩效的报销或 采购计划。 创新：实施PRO-QMS的热情超过了对以下相关问题的认真考虑 物流、统计、测量和意外后果。目前，方法还在开发中，以 评估结果是否存在足够的可变性，以证明实施PRO-QMS是合理的。中提议的工作 目标2将大大推进检查结果差异的方法的概念和统计基础 用于质量测量应用。在目标3中，我们建议全面审查 可操作和中试测试的过程质量措施(目标1)，为目标2收集PROM。信息 关于每个过程，测量的预测有效性对于未来的优先顺序和实施至关重要。 具体目标：目标1--完成以过程为导向的质量措施的制定和有效性测试 使用不同的管理数据集对CTS的治疗。目标2-评估测量特性 CTS的PRO-QMS。目标3-测试目标1中有希望的过程措施的预测有效性 方法：来自退伍军人管理局、联邦医疗保险和3所大学和社区系统的现有医疗数据将 用于检查当前提出但未充分测试的四个CTS的测量特性 过程质量措施(目标1)。患者报告的结果测量将从2000名患者中收集，共5 代表24名手外科医生的不同医疗保健环境，以检查设施之间和- 在初次就诊的患者中，外科医生对结果的改变存在差异 外科医生(目标2)。将使用结果来评估目标1中的过程测量的预测有效性 在目标2(目标3)收集的数据。 下一步/实施：支持具体质量措施有效性的研究结果将有助于 计划努力争取全国质量论坛认可，并为退伍军人手部外科医生提供优质 管理者和社区护理购买者是判断CTS治疗质量的一种手段。研究结果不符合 支持有效性的具体质量措施将被用来抵制其实施。

PROJECT SUMMARY/ABSTRACT Background: Efforts to measure, report, and incentivize the quality of healthcare are now widespread within the Veterans Health Administration (VA), Medicare, and private healthcare settings—but common musculoskeletal disorders including carpal tunnel syndrome (CTS) have been omitted from these efforts due to a lack of valid, feasible quality measures. Although clinical practice guidelines for the diagnosis and management of CTS have recently been published, no valid and feasible measures of these guidelines currently exist. Also, great interest exists across healthcare specialties in developing and implementing patient reported outcome measure-based quality measures (PRO-QMs). Before implementing process or outcome- based quality measures, it is essential to determine if they are valid and produce actionable information. Significance/Impact: VA is increasingly becoming a purchaser of community-based healthcare, making it essential to evaluate if healthcare quality measures are valid for both VA and cross-system comparisons. This proposal is aligned with VA ORD and HSR&D priorities including quality and safety, supporting the development of value-based payment models, methods for monitoring quality and safety of non-VA purchased care, and evaluating measures and methods to compare the quality of VA and non-VA care. The continued absence of valid CTS quality measures leaves all stakeholders without any means to identify quality gaps, evaluate the impacts of quality improvement initiatives, or to enact performance-based reimbursement or purchasing initiatives. Innovation: Enthusiasm for implementing PRO-QMs has outpaced careful consideration of issues related to logistics, statistics, measurement, and unintended consequences. Currently, methods are under-developed to evaluate if sufficient variability in outcomes exist to justify implementation of PRO-QMs. The work proposed in Aim 2 will significantly advance the conceptual and statistical basis of methods to examine outcome variance for quality measurement applications. In Aim 3, we propose to examine associations between fully operationalized and pilot tested process quality measures (Aim 1) with PROMs collected for Aim 2. Information about each process measure's predictive validity is essential for future prioritization and implementation. Specific Aims: Aim 1 – Complete development and validity testing of process-oriented quality measures for the treatment of CTS using diverse administrative datasets. Aim 2 – Evaluate the measurement characteristics of PRO-QMs for CTS. Aim 3 – Test the predictive validity of promising process measures from Aim 1 Methodology: Existing healthcare data from VA, Medicare, and 3 university and community systems will be used to examine the measurement characteristics of four currently proposed, but inadequately tested, CTS process quality measures (Aim 1). Patient reported outcome measures will be collected from 2000 patients in 5 diverse health care settings representing 24 hand surgeons to examine if meaningful between-facility and - surgeon variation exists in changes in outcome among patients receiving initial consultation with a hand surgeon (Aim 2). The predictive validity of the process measures in Aim 1 will be evaluated using the outcome data collected in Aim 2 (Aim 3). Next Steps/Implementation: Study results that support the validity of specific quality measures will facilitate planned efforts to pursue National Quality Forum endorsement, and provide VA hand surgeons, quality managers, and community care purchasers a means to judge CTS treatment quality. Study results that do not support the validity of specific quality measures will be used to resist their implementation.