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Issue 6: Industry News - October 2017
Table of Contents
- IHI: Quality Improvement Essentials Toolkit
- AMA Gathers 400+ Innovators for ChangeMedEd Conference
- NQF Issues Quality Roadmap for Reducing Healthcare Disparities
- Measuring the Cost of Quality Measurement
- NQF: Improving Diagnostic Quality and Safety Final Report
The Institute for Healthcare Improvement has introduced a new toolkit to help launch a successful quality improvement project and manage performance improvement. The QI Essentials Toolkit features 10 tools, each of which includes a brief description, instructions, an example, and a blank template. The tools can be used with the Model for Improvement, Lean or Six Sigma. The tools include a cause and effect diagram, failure modes and effects analysis, run charts and control charts, and a plan-do-study-act worksheet.
More than 400 innovators came together in mid-September for the American Medical Association's (AMA) ChangeMedEd 2017 conference in Chicago. The three-day conference sought to create a community of innovation that will continue to further change in medical education. "Over the past four years, the AMA has been working to identify the innovations needed to create the medical school of the future with 32 of the nation's leading medical schools," says AMA President Dr. David O. Barbe. "We've made tremendous progress in transforming the medical education system to ensure future physicians are prepared to meet the needs of patients in the modern health system, but we know that we must continue to grow our community of innovation to further affect change." At the conference, AMA introduced its new "Coaching in Medical Education Handbook," which offers best practices and recommendations for medical and health professions faculty who provide training for physicians-in-training and other clinicians. The handbook is one of several innovations developed through AMA's work with the 32-school Accelerating Change in Medical Education Consortium. Conference attendees also heard more about the innovative curriculum redesign projects being conducted as part of AMA's Accelerating Change in Medical Education initiative. In addition, there were interactive presentations from medical education professionals, providing participants with the latest information on recent innovations in curricula, educational redesign and technology.
The National Quality Forum (NQF) has released a roadmap detailing ways to use quality performance measures to eliminate healthcare disparities nationwide. Dr. Shantanu Agrawal, NQF's president and CEO, explains: "The health equity roadmap gives the nation a blueprint to eliminate healthcare disparities. NQF will support stakeholders in implementing these action steps through a new NQF Health Equity Program that will be launched in mid-October." The report highlights four specific actions: prioritizing efforts that can help to identify and monitor disparities; adopting evidence-based interventions to reduce disparities; investing in the development and use of measures to assess efforts that reduce disparities; and providing incentives to reduce disparities. The roadmap notes various ways its action steps may be applied—suggesting, for example, that hospitals and health plans identify and prioritize reducing disparities by stratifying and risk-adjusting performance measures by social risk factors that lead to disparities and determining which they can address in the short- and long-term. Another suggestion is that clinicians adopt evidence-based interventions by connecting patients to community-based services or culturally tailored programs designed to mitigate the drivers of disparities. Furthermore, measure developers should work with patients to translate concepts of equity into performance measures that can directly assess health equity, and policymakers and payers should incentivize the reduction of disparities and the promotion of health equity by building health equity measures into new and existing healthcare payment models. The roadmap—developed with funding from the U.S. Department of Health and Human Services—relied on input from a committee of public- and private-sector stakeholders, including payers, providers and patients.
A key goal of quality measurement activities is improving care, but the "current approach has produced an explosion of measures and a measurement system characterized by inefficiency and imbalance," write researchers from Boston Children's Hospital, Harvard Medical School and the University of Chicago. Measures can be overlapping, duplicative or over-representative, spurring calls to curb the proliferation of measures by identifying a small set of high-priority measures. Major organizations and hospitals are not including costs in decisions about which measures to use; but costs at multiple levels should all be considered, the authors write. They note there are several benefits of assessing cost explicitly and transparently and comparing the costs of similar measures. For example, making measurement costs explicit could prompt innovation in developing more cost-effective data collection. If the cost of a measure is made publicly available and included in decisions about its use, developers might be inclined to make their measure less expensive. The cost of reporting a chart-abstracted measure, such as several Hospital Inpatient Quality Reporting Program measures, could encourage developers to explore structured data or natural language processing. "Better understanding the cost of measures would not only inform decisions about which measures to use, but also guide future development of high-value measures that maximize benefit while optimizing use of finite quality measurement resources," the researchers conclude.
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A multi-stakeholder expert committee has created a conceptual framework for assessing diagnostic quality and safety for the National Quality Forum (NQF). The expert committee also worked to identify priorities for measure development going forward. The conceptual framework aims to facilitate identification and prioritization of measure gaps and also guide efforts to fill those gaps via measure development and endorsement. "As the field of healthcare continues to realize the need for diagnostic quality and safety, a measurement framework is a key component in assessing improvements," NQF notes. "The committee developed a comprehensive conceptual framework that provides structure and organization to this vast topic ... [and] hopes that this provides guidance to the field for both short-term improvements and aspirational initiatives." At least 5 percent of adults seeking outpatient care experience a diagnostic error, statistics show, contributing to nearly 10 percent of deaths each year and up to 17 percent of adverse hospital events.
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