In this video, I wanted to share with you some of the key entities involved in performance measurement across the globe. And talk a little bit about what are properties of a good performance measure. This slide outlines some of the major international performance measurement entities that I am familiar with. I recognize that they're probably many, many more involved in performance measurement, but I think these are some of the key ones that are driving change in the global healthcare marketplace. The National Quality Forum is a U.S. based nonprofit, Joint Commission International accredits hospitals located outside of the United States and they do a lot around performance measurement. In the previous video, we talked about ICHOM, two of the national entities involved in performance measurement include the Centers for Medicare Medicaid Services, CMS, here in the United States, the National Health Service in the United Kingdom including England and Scotland, plus there's many other national regional state and local entities involved in for performance measurement. I didn want to spend a little more time talking about the National Quality Forum because I think, this offers a particularly useful example for thinking about how we define what is a good performance measure. So as I made mention, the National Quality Forum is a non-for-profit organization here in the United States formed in 1999 by a coalition of public and private sector leaders. One of the organisations that I'd like to spend a little more time talking about is the National Quality Forum, as I believe, this really offers a great example of how to ensure what is a good performance measure. The National Quality Forum is a non-for-profit organization formed in 1999, by a coalition of both public and private sector leaders. The President's Advisory Commission on Consumer Protection and Quality in Health Care Industry, concluded at its ending that an organization like NQF was needed to promote patient protections and to ensure healthcare quality through both measurement and public reporting. NQF is developed an evidence based transparent measurement endorsement process and I am going to walk you through the four components of their endorsement process. NQF endorses performance measures, it does not develop measures and that's really an important distinction to make. So NQF itself doesn't actually develop performance measures, its role is to endorse performance measures that have been developed by other entities. As I mentioned, NQF is developed a criteria, four criteria, for endorsement, and I'm going to walk you through this four criteria. I think, they provide really an important example of how to ensure a measure is a good performance measure. The first criterion of the NQF endorsement process is the importance to measure and report. NQF wants to ensure that measures that are endorsed are evidence based and that the measure represents a area of care where significant gains can be made or where there is variation in the care being provided. So, the measure developer needs to demonstrate that there is a gap in performance that needs to be addressed. The second criterion that the NQF uses in its endorsement process is the scientific acceptability of measure properties. This addresses both the reliability of the measure and the validity of the performance measure. The reliability of the performance measure, you will want to ensure that the measure is well the define and precisely specified so that it can be implemented consistently within and across organizations and it allows for compare ability. The key word I would point out here is precisely and consistently. You will want to make sure that you are very clear with definitions and you will want to ensure that everyone applies the same definitions in the same way. Reliability can be demonstrated through two ways, one is intergrated reliability, the other one is looking at measurement error. And signal to noise is often a common measure of that measurement error. When we think about validity of a measure, what we are really talking about is, we want to ensure that the data elements are correct or that the measure score itself correctly reflects the construct of care that we are looking at and that it adequately identifies differences in quality. Validity can be demonstrated through a number of different ways including things such as face validity, does the measure appear to be relevant to the people or things that are being measured? It can be demonstrated through criterion validity. This is the extent to which the measures are demonstrated believe related to concrete criteria in the real world. Or it can be demonstrated through convergent validity. This is where the measure someone has been using is shown to be related to or have predictive abilities similar to those of another measure. The third criterion that's used as part of the NQF endorsement process is feasibility, and this one is so important. So you may have a great idea for a measure and you may have an important area to measure. But this idea of feasibility speaks to, can you actually get the data you need to measure performance? The measure specifications you will want to make sure you are using data that are readily available and can be captured without undue burden. So one example is data that resides in electronic health record but isn't easily pulled from the electronic health record. So this may be an example where you have a great idea for a measure but that data collection may not be feasible. Feasibility does link though to measurement frequency, the increased frequency of measurement does require greater feasibility. If you are measuring performance in an area every month or maybe every week that increase frequency, you will want to make sure that you can actually pull those data in a fairly easy way. If you are just measuring performance, say once a year, perhaps, you could deal with a little more burden and feasibility may not be as important. The fourth criterion that the National Quality Forum uses for endorsements process is usability and use. And the focus here is making sure that potential audiences can use the performance measures for both accountability and performance improvement, with the goal of achieving high quality efficient health care for both individuals and populations. What NQF requires is that entities that develop measures need to be using one of those measures in an accountability application within three years of initial endorsement, and the measure needs to be public reported within six years after initial endorsement. We talked earlier in an earlier video about the use of composite measures, in this slide, I provide actually three definitions of varying definitions of what a composite measure is. I provide a definition from the National Quality Forum, a definition from the Institute of Medicine, as well as a third definition. The National Quality Forum identifies the composite measure as a combination of two or more individual measures that are brought together into a single measure that results in a single score. The Institute of Medicine defines a composite measure as the bundling of measures for specific conditions to determine whether all critical aspects of care for a given condition have been achieved for an individual patient. The third definition focuses on a single measure of a construct that's defined in terms of two or more individual measures. So there's some real potential benefits to using composite measures. These include that they are really perhaps more patient centric and patient friendly, as it provides an overall summary of the quality of clear care delivered to the patient. It allows you to report both an overall score and allows you to report individual metrics, which may provide a more precise indicator of an improvement. And finally, composite measures often incorporate a comprehensiveness, where it captures the wide spectrum of care of a condition into a single measure, which may encourage quality improvement at a faster rate.
