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Issue 6: Industry News - September 2017
Table of Contents
- ACCME Data Report Shows Growth and Evolution of Accredited Continuing Medical Education
- The Future of Quality Improvement in Breast Cancer: Patient-Reported Outcomes
- How to Effectively Use the CMS Hospital Quality Star Ratings
- NCQA Updates Quality Measures for HEDIS 2018
- Improving Asthma Care by Building Statewide Quality Improvement Infrastructure
More than 1,800 accredited continuing medical education (CME) providers offered nearly 159,000 educational activities last year, according to a new report. The ACCME Data Report: Growth and Evolution in Continuing Medical Education — 2016, from the Accreditation Council for Continuing Medical Education (ACCME), reveals this education included more than 1 million hours of instruction and interactions with some 27 million healthcare professionals. The number of educational events increased 7 percent from 2015, while the number of instruction hours rose 9 percent and interactions with clinicians increased 5 percent. Overall, the number of activities and interactions has grown annually since 2010. The report also notes the number of interactions with non-physician healthcare professionals has increased steadily over the years, while the number of physician interactions has increased or remained relatively stable. "Every day, across the country, clinicians can choose from more than 3,000 hours of accredited CME," says Dr. Graham McMahon, president and CEO, ACCME. "Accredited CME is a tremendous resource — offering clinicians, educators, and health leaders the power and capacity to address many of the challenges we face in our changing healthcare environment."
Researchers from Beth Israel Deaconess Medical Center, Harvard Medical School, and the University of Pennsylvania discuss key factors behind monitoring the effectiveness of breast cancer care and guiding quality improvement. They note a number of implementations in breast cancer quality that have been responsible for furthering outcomes in breast care, including efforts focused on multidisciplinary care, patient navigation, shared decision-making, evidence-based guidelines, public awareness, and outcomes registries. To keep moving forward, they write, "will require us to move ever closer to the end results directly affecting patients and outcomes that matter most to breast cancer survivors. Patients often prioritize outcomes that differ from those prioritized by clinicians." To that end, a key factor affecting the future of quality improvement in breast cancer will be the systematic collection of patient-reported outcomes (PROs). Barriers to their routine incorporation into clinical practice include a lack of clear justification regarding the selection and use of PRO measures, and also that few are of sufficient psychometric quality to generate actionable data. The researchers call for greater understanding about how to interpret and apply the information gathered with PRO collection instruments, as well as greater compatibility and standardization to allow for comparison among groups of patients. In addition, they stress the need to be "thoughtful about the complexity, time needed for completion, and availability of translated and culturally sensitive options" for these systems. Technologies such as smartphones, mobile applications, and remote-monitoring devices also offer new opportunities to connect patients with the care team and to boost patient engagement. In conclusion, the researchers write, "The collection and analysis of PROs offers a unique opportunity to better understand clinical outcomes, correlate PROs with specific treatment paradigms and survival, and establish models of goal-directed quality care based on effective interventions."
The Centers for Medicare & Medicaid (CMS) released last year updated patient satisfaction and hospital quality star ratings. The five-point scale, first issued in 2014, is based on 64 quality measures. Although some groups said the ratings do not accurately reflect patient experience and hospital quality, former CMS Deputy Administrator for Innovation and Quality and CMO Patrick Conway explained at the time of release that the five-point model was selected because it was easy for consumers to understand. A new report from healthcare consultancy firm Deloitte investigates the efficacy of the star ratings and whether the ratings are an accurate reflection of hospital quality. In an interview, Deloitte's Center for Health Solutions Managing Director Sarah Thomas stresses the importance of CMS continuing to provide digestible studies of hospital quality and patient experience. According to the report, some category measures are weighed more heavily in the ratings than others — outcomes measures, for example, carry more weight in a star rating than do process measures. "It's not a bad thing that CMS has put more weight on those measures because those are, in fact, what a lot of consumers say they care about, as well as what physicians say they care about," Thomas explains. "A lot of consumers and a lot of consumer advocates value outcomes more than processes, and they certainly value the consumer experience." Thomas suggests that hospitals look at where they score low on all of the measures and then consider their patient population. Internal surveys — not just patient questionnaires and quality-related surveys — are also useful. The Deloitte report also highlights some areas for CMS to improve in terms of the star ratings. Thomas notes there are some gaps in measuring that help some hospitals more than others. Some smaller hospitals, for instance, may not have data to submit for particular measures; however, with no data submission, they do not risk lowering their score, while larger hospitals that do have that data may then receive lower scores. "We do recommend to CMS that they take a look at this system and think about other strategies they might do to take that issue into account," Thomas says.
The National Committee for Quality Assurance (NCQA) has released new technical specifications for the 2018 edition of the Healthcare Effectiveness Data and Information Set (HEDIS). The new HEDIS technical specifications include seven new measures, changes to four existing measures and two cross-cutting topics that address issues across multiple measures. The newest additions to HEDIS address emerging health needs and evolving processes in care delivery, such as Transitions of Care, which aims to improve care coordination during care transitions for at-risk populations including older adults and other individuals with complex health needs. Other new measures address Follow-Up After Emergency Department Visit for People With High-Risk Multiple Chronic Conditions, Use of Opioids at High Dosage, Use of Opioids from Multiple Providers, Depression Screening and Follow-Up for Adolescents and Adults, Unhealthy Alcohol Use Screening and Follow-Up, and Pneumococcal Vaccination Coverage for Older Adults. Among the changes to existing measures is a revision to the human papillomavirus vaccine rate to align with updated Advisory Committee on Immunization Practices guidelines, which now allow for a two-dose vaccination schedule for adolescents instead of three doses. The cross-cutting topics, meanwhile, focus on Telehealth for Behavioral Health Measures and Excluding Members in Institutional Care Settings.
Asthma care can be improved by supporting practice change via statewide quality improvement (QI) learning collaboratives, new research indicates. The goal of the Chapter Quality Network of the American Academy of Pediatrics (AAP) project and multiwave approach was to improve care for children with asthma and develop state-level expertise to support QI projects across entities in multiple states. For each cycle, a national leadership team coached multiple AAP chapter leadership teams, which then coached individual pediatric practices through two nested learning collaboratives. State chapters received data, reporting tools, and a curriculum fostering QI learning and support change at the practice level. Practices implemented an asthma assessment tool and registry, analyzed work flows, and implemented self-management tools in plan-do-study-act cycles. Chapter leaders provided feedback on sustainable QI change through surveys and interviews. The results show that optimal asthma care improved to 81 percent from 42 percent across the four waves. Additionally, the percentage of patients rated by physicians as well-controlled increased to 74 percent from 59 percent.
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