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

弥补治疗腕管综合症的可行、有效和重要的质量措施方面的差距

• 批准号: 10240300
• 负责人: Alex Sox-Harris
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10240300
• 关键词: Academy; Address; Administrator; Affect; American; Caring; Carpal Tunnel Syndrome; Case-Mix Adjustments; Characteristics; Clinical Practice Guideline; Code; Collaborations; Communities; Consultations; Data; Data Set; Development; Diagnosis; Future; Guidelines; Hand; Health Personnel; Health Professional; Healthcare; Healthcare Systems; Hospitals; ICD-9; Incentives; Intervention; Link; Logistics; Measurement; Measures; Medical center; Medicare; Methodology; Methods; Michigan; Modeling; Monitor; Musculoskeletal Diseases; Operative Surgical Procedures; Orthopedics; Outcome; Outcome Measure; Patient Outcomes Assessments; Patients; Performance; Persons; Policy Maker; Privatization; Process; Process Measure; Property; Provider; Publishing; Reporting; Research; Role; Safety; Science; Societies; Surgeon; Symptoms; Syndrome; System; Testing; United States; Universities; Validation; Variant; Veterans; Veterans Health Administration; Work; base; cost; health care quality; health care settings; implementation study; innovation; interest; medical specialties; payment; pilot test; predictive test; statistics

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.

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已经广泛 退伍军人卫生管理局（VA），医疗保险和私人医疗保健环境，但很常见 肌肉骨骼疾病在内 缺乏有效的，可行的质量措施。虽然诊断和 最近发布了CT的管理，没有这些准则的有效且可行的措施 目前存在。此外，在发展和实施患者方面，医疗保健专业之间存在着极大的兴趣 报告的基于结果测量的质量测量（Pro-QMS）。在实施过程或结果之前 - 基于质量措施，必须确定它们是否有效并产生可行的信息。 意义/影响力：VA越来越多地成为社区医疗保健的购买者 评估医疗保健质量措施是否有效的VA和跨系统比较至关重要。这 提案与VA ORD和HSR＆D的优先级一致，包括质量和安全，支持 开发基于价值的付款模型，购买非VA的质量和安全性的方法 护理，并评估比较VA和非VA护理质量的措施和方法。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， 评估质量改进计划的影响，或进行基于绩效的报销或 采购计划。 创新：实施Pro-QM的热情已经超过了对与之相关的问题的仔细考虑 物流，统计，测量和意外后果。目前，方法不发达 评估结果是否存在足够的变异性，以证明实施Pro-QMS是合理的。提出的工作 AIM 2将大大提高方法检查结果差异的概念和统计基础 用于质量测量应用。在AIM 3中，我们建议检查完全 通过为目标2收集的PROM进行操作和试点测试的过程质量指标（AIM 1）。 关于每个流程度量的预测有效性对于将来的优先级和实施至关重要。 具体目的：目标1 - 完整的开发和有效性测试，以过程为导向的质量度量 使用潜水员行政数据集对CT的处理。目标2 - 评估测量特征 CTS的Pro-QMS。 AIM 3 - 测试AIM 1的承诺过程度量的预测有效性 方法：来自VA，Medicare以及3大学和社区系统的现有医疗保健数据将是 用于检查当前提出的四个但未充分测试的CTS的测量特性 过程质量度量（AIM 1）。患者报告的结果指标将从2000名患者中收集5例 代表24位手部外科医生的各种医疗保健环境，以检查是否有意义，并且 - 外科医生在接受初次咨询的患者的结果变化中存在变化 外科医生（AIM 2）。 AIM 1中过程度量的预测有效性将使用结果评估 在AIM 2中收集的数据（AIM 3）。 下一步/实施：支持特定质量措施有效性的研究结果将有助于 计划寻求国家质量论坛认可的努力，并提供VA手部外科医生，质量 经理和社区护理购买者一种判断CTS治疗质量的方法。研究结果不 支持特定质量措施的有效性来抵抗其实施。