Cardio-Hit Phase II

描述(由申请人提供)：医疗质量改进的必要性几乎没有争议，但关于如何衡量和实现质量改进仍有相当大的争论。一个突出的问题与医生绩效衡量中排除(也称为例外)的使用有关：将患者从衡量的分母(和分子)中剔除，当这些患者出于某些正当理由不应包括在绩效计算中时。医生团体建议，排除有助于使措施的意图与医生进行临床判断的需要相一致，并包括对患者偏好的考虑。健康计划和雇主的代表对数据的准确性表示担忧，这些数据用于识别排除和潜在的游戏“漏洞”。电子健康记录系统(EHR)的绩效衡量开发人员和供应商必须在实现更高的准确性与收集数据的成本和复杂性之间取得平衡。对排除的担忧的解决取决于对国家医生业绩衡量中排除的流行率和模式的经验理解，而这一点目前还缺乏。 我们建议对异常报告进行为期两年的观察性研究，以我们之前在Cardio-HIT下的工作为基础，Cardio-HIT是一个由5个启用EHR的独立团体实践组成的研究协作，这些实践一直在收集数据并报告国家公认的冠心病和心力衰竭的医生绩效衡量标准。在我们提议的Cardio-HIT第二阶段项目中，我们将：(1)在这些措施中经验地记录异常报告的流行度和模式；(2)通过验证报告的异常样本来评估异常报告的可行性和准确性 手动EHR记录审查；以及(3)分析和解决利益相关者对例外报告的担忧，以完善医生绩效衡量设计中的现有原则。与这5个执业地点合作的是来自美国医学会、医师改进联盟召集人、国家质量保证委员会、爱荷华州医疗保健基金会和第一咨询集团的专家。

DESCRIPTION (provided by the applicant): The need for healthcare quality improvement is little disputed, yet considerable debate continues on how to measure and achieve quality improvement. One salient issue pertains to the use of exclusions (also called exceptions) in physician performance measures: the removal of patients from the denominator (and numerator) of the measure when these patients, for some valid reason, should not be included in the calculation of performance. Physician groups suggest that exclusions help to align the intent of the measures with the need of physicians to exercise clinical judgment and to include consideration of patient preferences. Representatives of health plans and employers have concerns about the accuracy of data for identifying exclusions and potential "loopholes" for gaming. Performance measure developers and vendors of electronic health record systems (EHRS) must balance attainment of higher accuracy against the cost and complexity of gathering data. Resolution of the concerns over exclusions is predicated on empirical understanding of the prevalence and patterns of exclusions in national physician performance measurement, which is currently lacking. We propose a 2-year observational study of exception reporting, building on our prior work under Cardio-HIT, a research collaborative of 5 EHRS-enabled independent group practices that have been collecting data and reporting on nationally recognized physician performance measures for coronary artery disease and heart failure. In our proposed Cardio-HIT Phase II project we will: (1) empirically document the prevalence and patterns of exception reporting in these measures; (2) assess the feasibility and accuracy of exception reporting by validating a sample of reported exceptions against manual EHRS record review; and (3) analyze and address stakeholder concerns regarding exception reporting to refine existing principles in the design of physician performance measures. Partnering with the 5 practice sites are experts from the American Medical Association, convener of the Physician Consortium for Performance Improvement; the National Committee on Quality Assurance; the Iowa Foundation for Medical Care; and First Consulting Group.