In this section, we present the approach we used to conduct this study. Figure 2.1 shows the organizing framework for our work. The environmental scan involved two main steps: (1) identification of the leading conditions treated and services/procedures provided in the outpatient setting (on the basis of cost and volume), and (2) identification of existing measures that may be applicable to outpatient care. In carrying out these steps, we conducted:
- An analysis of 2005 Medicare hospital outpatient data to determine conditions, services/procedures, and drugs/biologicals addressed in this setting,
- A scan for existing, publicly available measures potentially applicable to the hospital outpatient setting, and
- A series of semi-structured telephone discussions with representatives of medical specialty societies and hospital associations, informed by the analyses described in #1 and #2 above.
The methods for each of the data collection activities are described below. Having completed these data collection activities, we then synthesized the results to provide an initial assessment of which existing measures may reasonably apply to care provided in the hospital outpatient setting, and to identify gaps in those measures. This synthesis was used to inform our recommendations regarding next steps for advancing CMS’ measures development work in the hospital outpatient setting.
Due to the limited resources for this project, the work completed here should be viewed as a preliminary assessment which requires follow-on work to fully flesh out how to apply existing performance measures in this setting and where the most important measurement gaps are for guiding the use of resources in the future.
Figure 2.1. Framework Used in this Study
An environmental scan that takes the determing key conditions and procedures in the oupatient setting, and the determining measures that may be applicable to outpatient care; synthesizes the results, and identifies gaps; and recommends options for addressing the gaps.