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

项目总结/摘要 背景：衡量、报告和激励医疗保健质量的努力现在在医疗保健领域得到了广泛的应用。 退伍军人健康管理局（VA），医疗保险和私人医疗保健设置-但常见的 包括腕管综合征（CTS）在内的肌肉骨骼疾病已经从这些努力中省略， 缺乏有效可行的质量措施。虽然临床实践指南的诊断和 CTS的管理是最近公布的，这些指南没有有效和可行的措施 目前存在。此外，医疗保健专业对开发和实施患者 报告的基于结果测量的质量测量（PRO-QM）。在实施过程或结果之前- 基于质量措施，必须确定这些措施是否有效，并提供可采取行动的信息。 意义/影响：VA越来越成为社区医疗保健的购买者， 必须评估医疗质量指标是否对VA和跨系统比较有效。这 建议书与VA ORD和HSR&D的优先事项（包括质量和安全）保持一致， 开发基于价值的支付模式，监测非VA采购的质量和安全的方法 护理，评估措施和方法，比较VA和非VA护理的质量。继续 缺乏有效的CTS质量措施使所有利益相关者无法识别质量差距， 评估质量改进措施的影响，或制定基于绩效的报销，或 采购举措。 创新：对实施PRO-QM的热情超过了对以下问题的仔细考虑： 物流、统计、测量和意外后果。目前，方法开发不足， 评价结果是否存在足够的变异性，以证明实施PRO-QM的合理性。建议的工作 目标2将显著推进检验结果方差的方法的概念和统计基础 用于质量测量应用。在目标3中，我们建议全面检查 可操作和中试过程质量措施（目标1）与为目标2收集的PROM。信息 关于每一个过程测量的预测有效性是必不可少的未来的优先级和实施。 具体目标：目标1 -完成面向过程的质量措施的开发和有效性测试， 使用不同的管理数据集处理CTS。目标2 -评估测量特性 CTS的PRO-QM。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：将从VA、Medicare和3所大学和社区系统中收集现有的医疗保健数据， 用于检查四个目前提出的测量特性，但没有充分测试，CTS 过程质量措施（目标1）。将从5个研究中心的2000名患者中收集患者报告的结局指标。 代表24名手外科医生的不同医疗保健机构，以检查机构与 外科医生的差异存在的结果之间的变化，病人接受初步咨询的手 外科医生（目标2）。目标1中过程测量的预测有效性将使用结果进行评估 目标2（目标3）中收集的数据。 后续步骤/实施：支持特定质量措施有效性的研究结果将有助于 计划努力追求国家质量论坛的认可，并提供VA手外科医生，质量 管理人员和社区护理购买者判断CTS治疗质量的一种手段。研究结果不 支持特定质量措施的有效性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.