Bucketing the core measures
Much like it did with the accreditation standards, The Joint Commission is considering "recategorizing" the core measures into groups, says Jerod M. Loeb, PhD, executive vice president for quality measurement and research.
Now in its accreditation manual, The Joint Commission has further clarified elements by marking them as having either a direct or indirect impact on patient care as well as marking those elements that have data measurement requirements.
"[W]e're beginning finally to address the issue of looking at the experience base [with core measures]... and we're beginning to be able to essentially recategorize the measures," he says.
The first of the three "buckets" he's looking at now begins with those measures "that really ought to be used for accountability. These are the measures that have really good sound science behind them [in which] the process is closely linked to the outcome." These measures, backed by randomized, controlled trial evidence, he says, should be used for quality improvement, pay for performance, and accreditation. Such measures include use of aspirin, beta-blockers, ACE inhibitors, and angiotensin receptor blockers.
"Then there's sort of measures in this middle ground, which are measures we're calling 'measures for learning.' They're measures that should not be used, we believe, for pay for performance or accountability purposes, but probably represent good measures for use in internal quality improvement purposes, but they should not be publicly reported," Loeb says.
For instance, with smoking cessation the measures look at whether the advice and counseling was given while a patient was in the hospital. "It's not the process being measured," he says. "It's the documentation being measured. So we're beginning to think we ought not to be using those measures in that context and there ought not to be a whole lot of improvement efforts devoted to try to move those measure rates." He also cites a measure that involves dispensing heart failure discharge instructions. "By all means," he says, "it's the right thing to do, but we're not measuring the adequacy of how well those discharge instructions were understood by the patient. We're measuring the documentation."
The third bucket he refers to as "good advice." Such a measure "is something which probably represents the right thing to do, but on the other hand it ought not be used in the context of accountability or pay for performance or public reporting."
"Right now the measures are used identically. It doesn't matter which bucket the measure happens to sit in. And what we are in the process of doing, as I speak, is we're beginning to develop policies and procedures necessary to differentially get the measures," just as "we've done on the standards side of the business."
Much like it did with the accreditation standards, The Joint Commission is considering "recategorizing" the core measures into groups, says Jerod M. Loeb, PhD, executive vice president for quality measurement and research.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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