Cardio-Hit Phase II

描述（由申请人提供）：医疗保健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。一个突出的问题与在医生绩效评估中使用排除（也称为例外）有关：当这些患者由于某些正当理由不应包括在绩效计算中时，将患者从衡量的分母（和分子）中移除。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保持一致，并考虑到患者的偏好。健康计划的代表和雇主都担心数据的准确性，以确定排除和潜在的游戏“漏洞”。电子健康记录系统（EHRS）的性能度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。对排除的关注的解决是基于对国家医生绩效测量中排除的患病率和模式的经验理解，这是目前缺乏的。

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.