Set Of Quality Measures Research Articles

Using continuous glucose monitoring to measure and improve quality metrics: Updates on the Healthcare Effectiveness Data and Information Set 2024 Glucose Management Indicator measure.

Value-based diabetes care is a proactive approach to providing quality care to individuals with diabetes. This approach focuses on improving clinical outcomes rather than the volume of services provided. Implementation of value-based diabetes care requires an established set of standardized quality measures against which all stakeholders can assess and benchmark their performance. The National Committee for Quality Assurance recently added the Glucose Management Indicator to its Healthcare Effectiveness Data and Information Set. The Glucose Management Indicator can be used as a measure of glucose control. This article discusses the benefits of value-based care, the importance of diabetes quality measures, and how the rapidly increasing adoption of continuous glucose monitoring is impacting these measures while improving the lives of individuals with diabetes.

Impact of a diabetic retinal exam screening program on quality measure gaps at a family medicine practice

BackgroundDiabetic retinopathy is a common complication in people with diabetes, and annual screening is recommended by the American Diabetes Association. This annual exam is also a Health Effectiveness Data and Information Set quality measure. Barriers such as lack of access to healthcare or cost of specialist visits may impact the number of patients who receive these exams. ObjectiveThe objective of this study is to describe the impact of a diabetic retinal exam screening program at a rural family medicine center on the number of quality measure gaps resolved. Practice descriptionThis study occurred at a rural family medicine center in southwestern Pennsylvania with a medically underserved patient population. A pharmacist at the site holds board certifications in Advanced Diabetes Management and as a Diabetes Care and Education Specialist. This pharmacist manages diabetes through a collaborative practice agreement. Practice innovationA regional Medical Assistance plan provided a list of patients with a quality measure gap for an annual diabetic retinal exam and loaned a RetinaVue 700 Imager to take retinal photos. After screening eligible patients via phone, retinal exams were administered by student pharmacists and medical assistants to consenting patients over the course of 9 days. Images were then sent to an ophthalmologist to be interpreted. Evaluation methodsThe rate of quality measure gaps closed and satisfaction survey results are reported using descriptive statistics. ResultsA total of 61 patients were included in the analysis. This program closed quality measure gaps for 11 (18.0%) patients who were able to receive an in-office eye exam. ConclusionThis pilot project shows that offering in-office diabetic retinal exams may be an effective strategy to close quality measure gaps and provide access to screening among a medically underserved population.

Comparing methods for assessing the reliability of health care quality measures.

Quality measurement plays an increasing role in U.S. health care. Measures inform quality improvement efforts, public reporting of variations in quality of care across providers and hospitals, and high-stakes financial decisions. To be meaningful in these contexts, measures should be reliable and not heavily impacted by chance variations in sampling or measurement. Several different methods are used in practice by measure developers and endorsers to evaluate reliability; however, there is uncertainty and debate over differences between these methods and their interpretations. We review methods currently used in practice, pointing out differences that can lead to disparate reliability estimates. We compare estimates from 14 different methods in the case of two sets of mental health quality measures within a large health system. We find that estimates can differ substantially and that these discrepancies widen when sample size is reduced.

Software-driven chronic disease management: Algorithm design and implementation in a community-based blood pressure control pilot

Background: Optimal guideline-directed medical therapy is rarely attained in practice, resulting in inadequate control of diseases such as hypertension, with poorer results in under-resourced communities. Technology, including artificial intelligence-driven decision support and software-driven workflow transformation, can potentially improve disease outcomes at a reduced cost, although it must be integrated with a holistic approach. Methods: We describe the design of a software platform that enables rapid iterative remote management of >20 conditions across cardiac-kidney-metabolic disease. The platform distributes work across a care team of providers and care navigators, automates decision-making, ordering, and documentation, supports rapid incorporation of new evidence, and launches pragmatic trials. We describe software used in a 500-person community-based blood pressure control implemented as a single-arm quality improvement program. The primary endpoint was the proportion of patients meeting the Healthcare Effectiveness Data and Information Set quality measure blood pressure goal (<140/90) at 12 weeks. Results: A total of 1609 patients were screened, 945 (59%) were found to have uncontrolled hypertension, and 512 patients consented to join the program. The average age was 61 ± 11 years; 59% were female, and 99% self-identified as Black. Blood pressure distribution was: 10% Stage 1 (SBP 130–139 mmHg or DBP 80–89 mmHg), 69% Stage 2 (SBP 140–179 mmHg or DBP 90–119 mmHg), and 21% Stage 3 (SBP >180 mmHg or DBP >120 mmHg). Two hundred four patients (39%) proceeded to a provider encounter, and 160 of these (78%) completed the program. The Healthcare Effectiveness Data and Information Set blood pressure goal was achieved in <12 weeks of enrollment for 141 participants (69% of those enrolled, 88% of those who completed the program). Conclusion: Software-driven remote blood pressure is feasible, although strategies to improve patient enrollment will be needed to achieve maximum impact. Future work will be required to compare outcomes to usual care and evaluate concurrent management of multiple cardiac-kidney-metabolic conditions.

International Clinical Radiotherapy Audit in CCCN- iPAAC Project.

Project iPAAC - Innovative Partnership for Action Against Cancer was a project in which 2 centers in Europe were selected for international certification (Lower Silesian Oncology Center and Charité Hospital). We were subjected to general certification under CCCN and organ certification for colorectal and pancreatic cancer. The certification process included the reporting of a set of standards books (general and specific) and quality measures - 35 for colorectal and 21 for pancreatic cancer, an onsite presentation at an audit and a site visit. Radiation therapy was one of 10 table of contents sections. These sections included a description of the structure of the facility including satellite units, equipment and systems integration, the number of patients treated, the team of radiation oncologists, medical physicists, medical technical radiology assistants. In addition, crucial elements were the reporting of waiting time and overrun of total treatment time. We have begun the process of standardizing data entry, acquisition and reporting using the Aria v.15.6 management and verification system with InSightive. The following metrics proved to be key to RT application and quality: QI13 - information on distance to mesorectal fascia, OI26 - quality of TME rectum specimen, QI27 - complete pathology report of colorectal carcinoma, QI2add - neoadjuvant RT/CRT clinical UICC stages II and III. For the calculation of QI, the MSD Data Warehouse system was used. The final audit was performed on the time frame data from 1.01.-31.05.2021. The project lasted from the signing of the tripartite agreement on 7.06.2019 through the pre-audit on 10-11.09.2020 and the audit on 1-2.07.2021 until the certification on 16.09.2021. We have fulfilled mostly set of standard general and specific for colorectal and pancreatic cancer. The SOP for the management of LINAC breakdowns, and radiochemotherapy was detailed. According to the data obtained from the InSightive: the number of patients treated with teleradiotherapy by 31.05.2021 was 2298, and with brachytherapy - 167. The system allowed, with the help of an automated dashboard, to determine the average planning time of 15.3 days and to monitor the overrun of the total treatment time of 0.14% for Wrocław, and 0.31% and 0% for satellite units (in 2020 - 4.5% during Covid pandemics). The percentage results for the reported metrics are as follows: QI13 - 38.65% QI26 - 89.29% QI- 27 - 59.21% QI2add - 80%. In the international audit radiation oncology was summarized in the audit report as very high level and as leading position of CCCN and the chapter of set of standards has been implemented on a wide scale. International audit with set requirements allows to check the resources on personnel, equipment and to complete the missing procedures (SOP). The most objective tools for auditing are quality metrics, and their collection should be automated, allowing for a continuous ongoing quality assurance process.

Quality measures for the care of pediatric patients with obstructive sleep apnea: 2023 update after measure maintenance.

Lloyd RM, Crawford T, Donald R, etal. Quality measures for the care of pediatric patients with obstructive sleep apnea: 2023 update after measure maintenance. J Clin Sleep Med. 2024;20(1):127-134.

Multisite Quality Improvement Program Within the Project ECHO Diabetes Remote Network

The telementoring Project ECHO (Extension for Community Healthcare Outcomes) model has been shown to improve disease management in diabetes in many underserved communities. The authors aim to evaluate if ECHO could also be an effective tool for quality improvement (QI) of diabetes care in these communities. Thirteen clinics in underserved communities in California and Florida participating in Project ECHO Diabetes were recruited for a 12-month QI program. The program provided weekly tele-education sessions, including a didactic presentation and case-based discussion. In addition, clinics chose their own set of quality measures to improve and met remotely to discuss their efforts, successes, and setbacks every quarter with mentorship from QI experts. Of the 31 QI initiatives attempted by different clinics, all had either made improvements (25 initiatives, 80.6%) or were in the process of making improvements (6 initiatives, 19.4%) in structural, process, and outcome measures. Examples of these measures include whether clinics have protocols to identify high-risk patients (structure), numbers of continuous glucose monitor prescriptions submitted by the clinics (process), and percentage of patients with diabetes whose most recent HbA1c are > 9% (outcome). For one measure, 40.0% of the clinics had achieved a higher percentage of cumulative HbA1c measurement in the third quarter of the year, compared to the fourth quarter in the previous year. The cost of QI implementation varied widely due to different number of personnel involved across sites. A QI program delivered via Project ECHO Diabetes can facilitate quality improvements in underserved communities.

Amyotrophic Lateral Sclerosis Quality Measurement Set 2022 Update: Quality Improvement in Neurology.

Amyotrophic Lateral Sclerosis Quality Measurement Set 2022 Update: Quality Improvement in Neurology.

Pediatric Rheumatology Care and Outcomes Improvement Network's Quality Measure Set to Improve Care of Children With Juvenile Idiopathic Arthritis.

To describe the selection, development, and implementation of quality measures (QMs) for juvenile idiopathic arthritis (JIA) by the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), a multihospital learning health network using quality improvement methods and leveraging QMs to drive improved outcomes across a JIA population since 2011. An American College of Rheumatology-endorsed multistakeholder process previously selected initial process QMs. Clinicians in PR-COIN and parents of children with JIA collaboratively selected outcome QMs. A committee of rheumatologists and data analysts developed operational definitions. QMs were programmed and validated using patient data. Measures are populated by registry data, and performance is displayed on automated statistical process control charts. PR-COIN centers use rapid-cycle quality improvement approaches to improve performance metrics. The QMs are revised for usefulness, to reflect best practices, and to support network initiatives. The initial QM set included 13 process measures concerning standardized measurement of disease activity, collection of patient-reported outcome assessments, and clinical performance measures. Initial outcome measures were clinical inactive disease, low pain score, and optimal physical functioning. The revised QM set has 20 measures and includes additional measures of disease activity, data quality, and a balancing measure. PR-COIN has developed and tested JIA QMs to assess clinical performance and patient outcomes. The implementation of robust QMs is important to improve quality of care. PR-COIN's set of JIA QMs is the first comprehensive set of QMs used at the point-of-care for a large cohort of JIA patients in a variety of pediatric rheumatology practice settings.

Health Systems Need to Transform Data Collection to Advance Health Equity.

Health Systems Need to Transform Data Collection to Advance Health Equity.

Modernizing payment to critical access hospitals: A proposal for the next iteration of the Flex Program.

Modernizing payment to critical access hospitals: A proposal for the next iteration of the Flex Program.

Quality Measures in Systemic Sclerosis

Quality improvement is an emerging field, that applies principles of improvement science and utilizes measurement methods with the aim of improving patient care. Systemic sclerosis (SSc) is a systemic autoimmune rheumatic disease associated with increased healthcare burden, cost, morbidity, and mortality. Gaps in delivering care to patients with SSc have been consistently observed. In this article, we introduce the discipline of quality improvement and its use of quality measures. We summarize and comparatively evaluate three sets of quality measures that have been proposed to evaluate the quality of care of patients with SSc. Finally, we highlight the areas of unmet needs and indicate future directions for quality improvement and quality measures in SSc.

Paying for Nursing Home Quality: An Elusive But Important Goal.

Paying for Nursing Home Quality: An Elusive But Important Goal.

P159 Development of a core set of quality of care measurements for patients with inflammatory bowel disease in Belgium

Abstract Background Uniform and standardized quality indicator (QI) measurement allows to assess quality of care (QoC) and set up quality improvement initiatives. To date there is no uniform measurement of QoC in IBD centres in Belgium. We therefore aimed to adapt existing standards of QoC to practical local needs, and to define a core set of quality measurements (QM) through a multi-stakeholder consensus. Methods A Core Team (4 IBD expert clinicians, 3 researchers) prepared and coordinated the Delphi process (Figure). Through a literature review, 221 existing QIs for IBD were identified. Second, an importance rating scale exercise was performed, leading to 58 QIs that were reformulated into practical QMs. Next, a variety of experts from different centres in Flanders were invited to rate the importance of these 58 QMs on a 10-point Likert scale. In between two consecutive online voting rounds, expert and patient (n=93) perspectives were provided. Furthermore, participants could also suggest items that were missing in the pre-selected list. A consensus threshold of ≥80% of the participants scoring the item 7, 8, 9 or 10 in voting round 2 was applied as the cut-off criterion for an item to be directly included in the final set of QMs. Newly suggested items and items that did not reach the cut-off criterion were discussed and reconsidered for inclusion in the final set during a closing consensus meeting. In order to come to a workable selection of items, participants to the consensus meeting were requested to estimate the potential for improvement of each of the selected QMs. Results In total 40 stakeholders of which 29 IBD clinicians, 7 IBD nurses, 2 paediatricians, 1 abdominal surgeon and 1 chief medical officer from 24 different Flemish centres participated in both Delphi voting rounds. Of this group, 21 IBD clinicians, 3 IBD nurses and 2 paediatricians also participated in the virtual consensus meeting. In total, 50 items reached the cut-off criterion for direct inclusion in the final QM set, the other 8 items and also 3 new items were discussed and re-voted during the consensus meeting of which 8 additionally reached the cut-off criterion to include in the final set. Based on the estimated improvement potential, 19 of these 58 QMs were prioritized and agreed to measure in clinical practice (Table). Conclusion We defined a core set of 58 QMs for IBD based on multi-stakeholder consensus. In the next phase of this project, a more condensed subset of 19 QMs with potential for improvement will be measured in IBD centres across Belgium, allowing QoC assessment, benchmarking and quality improvement initiatives.

Machine Learning–Enabled NIR Spectroscopy. Part 2: Workflow for Selecting a Subset of Samples from Publicly Accessible Data

An increasingly large dataset of pharmaceutics disciplines is frequently challenging to comprehend. Since machine learning needs high-quality data sets, the open-source dataset can be a place to start. This work presents a systematic method to choose representative subsamples from the existing research, along with an extensive set of quality measures and a visualization strategy. The preceding article (Muthudoss et al.. in AAPS PharmSciTech 23, 2022) describes a workflow for leveraging near infrared (NIR) spectroscopy to obtain reliable and robust data on pharmaceutical samples. This study describes the systematic and structured procedure for selecting subsamples from the historical data. We offer a wide range of in-depth quality measures, diagnostic tools, and visualization techniques. A real-world, well-researched NIR dataset was employed to demonstrate this approach. This open-source tablet dataset (http://www.models.life.ku.dk/Tablets) consists of different doses in milligrams, different shapes, and sizes of dosage forms, slots in tablets, three different manufacturing scales (lab, pilot, production), coating differences (coated vs uncoated), etc. This sample is appropriate; that is, the model was developed on one scale (in this research, the lab scale), and it can be great to investigate how well the top models are transferable when tested on new data like pilot-scale or production (full) scale. A literature review indicated that the PLS regression models outperform artificial neural network-multilayer perceptron (ANN-MLP). This work demonstrates the selection of appropriate hyperparameters and their impact on ANN-MLP model performance. The hyperparameter tuning approaches and performance with available references are discussed for the data under investigation. Model extension from lab-scale to pilot-scale/production scale is demonstrated.Highlights• We present a comprehensive quality metrics and visualization strategy in selecting subsamples from the existing studies• A comprehensive assessment and workflow are demonstrated using historical real-world near-infrared (NIR) data sets• Selection of appropriate hyperparameters and their impact on artificial neural network-multilayer perceptron (ANN-MLP) model performance• The choice of hyperparameter tuning approaches and performance with available references are discussed for the data under investigation• Model extension from lab-scale to pilot-scale successfully demonstratedGraphical

IMPACT OF FACTORS AFFECTING CUSTOMER SATISFACTION TOWARDS CORPORATE LOAN IN THE BANKING SECTOR OF BANGLADESH

The purpose of this paper is to determine customer satisfaction with corporate loans. Corporate lending in Bangladesh is making a large attitude. The assessment's primary goal is to conduct a thorough inquiry into the fulfillment of borrowers from Rupali Bank Limited. According to the review, Rupali Bank Limited has excellent employees in terms of behavior, and customer happiness is an important factor in evaluating the bank's performance. Using a self-administered survey, a confirmatory factor analysis, and a set of quality measures adopted from the existing literature. We reaffirm that factors of perceived satisfaction with regard to corporate loans in the context of Bangladesh include interest rate, information availability, policies and charges as well loan repayment procedure. For data analysis, factor loading through PCA and regression were applied. Results revealed that interest rate, information availability, policies and charges as well loan repayment procedure are positively related with customer satisfaction towards corporate loan. However, this study is a genuine contribution towards the corporate loan sector of Bangladesh. Our findings have relevance for academics and practitioners interested in understanding customers' ultimate needs.

Development of a core outcome set for quality of life for adults with drug-resistant epilepsy: A multistakeholder Delphi consensus study.

In 2017, the American Academy of Neurology (AAN) convened the AAN Quality Measurement Set working group to define the improvement and maintenance of quality of life (QOL) as a key outcome measure in epilepsy clinical practice. A core outcome set (COS), defined as an accepted, standardized set of outcomes that should be minimally measured and reported in an area of health care research and practice, has not previously been defined for QOL in adult epilepsy. A cross-sectional Delphi consensus study was employed to attain consensus from patients and caregivers on the QOL outcomes that should be minimally measured and reported in epilepsy clinical practice. Candidate items were compiled from QOL scales recommended by the AAN 2017 Quality Measurement Set. Inclusion criteria to participate in the Delphi study were adults with drug-resistant epilepsy diagnosed by a physician, no prior diagnosis of psychogenic nonepileptic seizures or a cognitive and/or developmental disability, or caregivers of patients meeting these criteria. A total of 109 people satisfied inclusion/exclusion criteria and took part in Delphi Round 1 (patients, n= 95, 87.2%; caregivers, n= 14, 12.8%), and 55 people from Round 1 completed Round 2 (patients, n= 43, 78.2%; caregivers, n= 12, 21.8%). One hundred three people took part in the final consensus round. Consensus was attained by patients/caregivers on a set of 36 outcomes that should minimally be included in the QOL COS. Of these, 32 of the 36 outcomes (88.8%) pertained to areas outside of seizure frequency and severity. Using patient-centered Delphi methodology, this study defines the first COS for QOL measurement in clinical practice for adults with drug-resistant epilepsy. This set highlights the diversity of factors beyond seizure frequency and severity that impact QOL in epilepsy.

NewsCAP: CMS releases first home- and community-based services quality measure set.

NewsCAP: CMS releases first home- and community-based services quality measure set.

Reprint of: Development and Evaluation of a Global Malnutrition Composite Score.

Reprint of: Development and Evaluation of a Global Malnutrition Composite Score.

Measuring geographic variation in quality and equity of breast cancer care.

139 Background: Persistent higher breast cancer mortality among Black Americans is partly due to treatment disparities. There is a paucity of surveillance data quantifying racial disparities at local levels, and the relationship of geography to racial disparities in treatment is poorly understood. We sought to develop and apply a claims-based set of breast cancer quality measures, stratified by race, across regions of North Carolina. Methods: We created a retrospective cohort (n = 37,021) of stage I-III breast cancers from 2004-2017 using linked cancer registry and multi-payer claims data. We assessed 4 quality measures derived from ASCO/NCCN and Commission on Cancer including chemotherapy (CT) for hormone receptor negative disease, radiation (RT) after breast conserving surgery (BCS), RT for N2-3 disease, and adjuvant endocrine therapy (ET). Each measure was limited to the ages and tumor features eligible by the ASCO/NCCN/CoC guideline. We estimated age-adjusted overall performance (%) on each measure, and the Black-White gap, at the state level and across 9 geographic sub-regions. We used multivariable Poisson regression to estimate Risk Ratios (RR) comparing quality performance for Black vs. White patients overall and across regions. Exploratory analyses adjusted for patient- and neighborhood-level social determinants of health (SDOH). Results: Median age of the cohort was 68 years and 19% of patients were Black. At the state level, the % of eligible patients meeting quality measures ranged from 73% for adjuvant ET to 95% for RT after BCS. There was significant inter-region variation on all 4 measures. Black patients were less likely to receive adjuvant CT (RR = 0.92, CI 0.87-0.96), post-BCS RT (RR = 0.98, CI 0.97-0.99) and ET (RR = 0.95, CI 0.93-0.98). There was no racial disparity in RT for N2-3 disease. Both overall performance and the magnitude of disparity varied widely across regions and geographic patterns were not consistent across measures. For example, the Charlotte region had the top quality performance for RT for N+ (90%), but worst for ET (70%). Similarly, the Wake region had no racial disparities in CT or RT, but the largest disparity of any region for ET (RR = 0.90, CI 0.84-0.96). Adjustment for SDOH modestly attenuated the relationship between race and quality performance, but significant disparities persisted in the regions with the largest racial gaps. Conclusions: Racial disparities persist in breast cancer care delivery, but with non-uniformity of performance across measures and varying local patterns of disparities. Our findings suggest that cross-cutting interventions spanning the care continuum, and/or interventions adapted to local challenges, may be needed to effectively address racial disparities. The contributions of local resources, structural, and institutional barriers to these patterns remain to be explored. Community-engaged work to share and interpret these findings is ongoing.