Public Health

Performance Measurement in the Hospital Outpatient Setting. Safety

A large number of existing patient safety measures apply primarily to care provided in the inpatient setting (e.g., Leapfrog’s Safety Leaps, AHRQ’s Patients Safety Indicators (PSIs), and the SCIP measures). However, a number of these safety measures that apply more universally — such as a culture of safety, hand washing and other infection

Performance Measurement in the Hospital Outpatient Setting. Patient-Centeredness

Although the CAHPS Hospital, and Clinician & Group Surveys provide a strong source of measures that could be used to evaluate patient-centeredness in the hospital outpatient setting, patient experience measures are lacking that address the provision of clinical care, such as the reporting of specific test results. At present there are also no

Performance Measurement in the Hospital Outpatient Setting. Equity

Although there is widespread awareness of health disparities by population subgroups, our review did not identify any specific measures of equity. However, many existing measures could be applied and the results stratified by various sub-populations to determine where disparities are occurring and to focus attention on closing these gaps provided

Performance Measurement in the Hospital Outpatient Setting. Efficiency

Discussants stressed the existence of a significant and growing interest in efficiency measures. At this time, existing efficiency measures reflect measures of relative resource utilization and have not taken into account differences in quality by resource use. Existing efficiency measures have been applied primarily by private sector health plans

Performance Measurement in the Hospital Outpatient Setting. Effectiveness

While we found many measures of clinical effectiveness, our analysis also revealed a number of key gaps in existing measures:

Performance Measurement in the Hospital Outpatient Setting. Identification of Gaps in Measures

In conducting our gap analysis, we considered how the measures identified in our review relate to the six aims identified by the IOM (2001) as being critical to ensuring a high-quality health care system: (1) effectiveness, (2) efficiency, (3) equity, (4) patient-centeredness, (5) safety, and, (6) timeliness.

Performance Measurement in the Hospital Outpatient Setting. Synthesis of Measures Relating to Drugs and Biologicals

Few measures were identified that address the use or dosing of drugs and biologicals (based on G, H, and K codes) that are paid separately under OPPS. The vast majority of identified measures address the use of cancer chemotherapy. The identification or development of measures that specifically focus on high-volume drugs and biologics that represe

Performance Measurement in the Hospital Outpatient Setting. Synthesis of Measures Relating to Services/Procedures

Our synthesis of existing measures and the most frequent and costly services/procedures (based on S codes) performed in the HOPS revealed that there are a few publicly available existing measures to address these services/procedures. Topics addressed by existing measures include cataract extraction, indications for cardiac catheterization, colonos

Performance Measurement in the Hospital Outpatient Setting. Synthesis of Measures Relating to Reasons for Visits

Table 4.1 presents the key diagnostic categories that we identified as the reasons for visits (based on V codes) to the HOPS by Medicare beneficiaries in 2005, and the corresponding counts of publicly available measures that pertain to these diagnoses. A more thorough review of the measures would be required to fully consider their applicability a

Performance Measurement in the Hospital Outpatient Setting. Syntheses of Measures

Performance Measurement in the Hospital Outpatient Setting. Mapping of Clinical Measures

Figure 4.1 provides an overview of our mapping of existing measures to HOPS and ED encounter data. Encounters were grouped into three categories in our analyses: visits, drugs/biologicals, and services/procedures. For each category, we considered the types of activities that typically occur during the encounters. We then used this assessment to de

Performance Measurement in the Hospital Outpatient Setting. IV. Synthesis of Existing Measures and Identification of Gaps. Synthesis of Existing Measures and Identification of Gaps

In this chapter, we draw from our analysis of 2005 Medicare data, scan of publicly available existing measures, and discussions with medical specialty societies and hospital associations to synthesize the reach of existing measures and identify the gaps in potential measures for the HOPS and ED. We also describe several data collection challenges

Performance Measurement in the Hospital Outpatient Setting. Measures that Are Lacking

Discussants noted that measures are missing in several key areas:

Performance Measurement in the Hospital Outpatient Setting. Measures in the Development Pipeline

Our discussions with representatives of medical specialty societies and hospital associations yielded information about other measures currently under development. According to the representatives with whom we spoke, CMS’s pressing need to respond to the legislative mandate set forth in the TRHCA of 2006 has significantly increased interest in a

Performance Measurement in the Hospital Outpatient Setting. Existing Measures

Our review of publicly available performance measures revealed that there are few clinical performance measures that are being used to assess care provided at the hospital outpatient facility level. The exception is five ED measures recently developed by the OFMQ, which address the timing of care for acute myocardial infarction (AMI). Discussants

Performance Measurement in the Hospital Outpatient Setting. Findings from the Scan of Existing Measures and Discussions

Below we summarize the findings from our scan of existing, publicly available performance measures and discussions with representatives of medical specialty societies and hospital associations. Our review identified nearly 600 measures that may be potentially relevant to application in the hospital outpatient setting.

Performance Measurement in the Hospital Outpatient Setting. Most Frequent Used Drugs and Biologicals in the Hospital Outpatient Setting and Emergency Department

Table 3.6 shows the 50 most frequent, separately billed drugs and biologicals associated with services in the HOPS and ED. 28 In both the HOPS and ED, imaging contrast material, blood products and medications associated with cancer chemotherapy are among the most frequently used. In the ED, several thrombolytic agents are also frequently used. Th

Performance Measurement in the Hospital Outpatient Setting. Services/Procedures and Associated Diagnoses Representing the Largest Share of Costs in the Hospital Outpatient Setting and Emergency Department

Tables 3.4 and 3.5 highlight the 20 costliest services/procedures in the HOPS and ED, respectively, as well as the associated diagnoses based upon analysis of 2005 Medicare data with 2007 APC payment rates applied. 25 These data show that, had 2007 payment rates been in force in 2005, many of the most common services/procedures also would have ac

Performance Measurement in the Hospital Outpatient Setting. Most Commonly Provided Services/Procedures and Associated Diagnoses in the Hospital Outpatient Setting and Emergency Department

Tables 3.2 and 3.3 highlight the 20 most common classes of services/procedures, grouped by APC, and their associated diagnoses in the HOPS and ED setting, respectively, based upon the analysis of 2005 Medicare data. For each of the APCs presented in the table, the five most common primary diagnosis groups associated with the APC are presented. In

Performance Measurement in the Hospital Outpatient Setting. Common Reasons for Visits in the Hospital Outpatient Setting and Emergency Department

Figures 3.1 and 3.2 and Table 3.1 highlight the common reasons for E&M visits to the HOPS and ED. The clinical categories in Figures 3.1 and 3.2 represent 100 percent of the primary diagnoses associated with visits to the HOPS and ED, respectively, and are organized alphabetically. Table 3.1 provides additional information for the clinical cat

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