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的争论仍在继续。一个突出的问题涉及在医生绩效指标中使用排除（也称为例外）：当这些患者出于某种正当原因不应纳入绩效计算时，将患者从指标的分母（和分子）中删除。医生团体建议，排除有助于调整措施的意图与医生需要行使临床判断，并包括考虑病人的喜好。健康计划和雇主的代表对用于确定排除和游戏潜在“漏洞”的数据的准确性表示担忧。电子健康记录系统（EHRS）的性能测量开发人员和供应商必须在获得更高的准确性与收集数据的成本和复杂性之间取得平衡。排除的关注的解决是基于经验的理解，在国家医生的绩效衡量，这是目前缺乏的普遍性和模式的排除。 我们提出了一项为期2年的异常报告观察性研究，建立在我们之前在EHRS-HIT下的工作基础上，EHRS-HIT是一项由5个EHRS-enabled独立小组实践组成的研究合作，这些实践一直在收集数据并报告国家认可的冠状动脉疾病和心力衰竭的医生绩效指标。在我们提出的EST-HIT第二阶段项目中，我们将：（1）以经验为依据记录这些措施中异常报告的普遍性和模式;（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EHRS记录审查;分析和解决利益相关者对例外报告的关注，以完善医生绩效评估设计中的现有原则。与5个实践地点合作的是来自美国医学协会的专家，他们是提高绩效医生联盟的召集人;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。

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.