Performance measures (PMs) are specified metrics by which a health-care provider's care can be compared with national benchmarks. The use of PMs is a key component of efforts to improve the quality and value of health care. The National Quality Forum (NQF) is the federally recognized endorser of PMs. From 2006 to 2009, the Quality Improvement Committee (QIC) of the American College of Chest Physicians engaged in the review of proposed PMs as a member of the NQF. This article provides a review of the QIC's experience with PMs and NQF membership and the lessons learned, an overview of the enhancements made to the NQF endorsement process in 2010 and 2011, and a discussion of the next steps that would further strengthen the measure development and endorsement processes and increase the likelihood of measurement leading to better patient outcomes.

Editorials4 September 2012The Importance of Accurate Data in Quality-of-Care MeasurementBernard Rosof, MDBernard Rosof, MDFrom North Shore-LIJ Health System, Huntington, NY 11743.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-5-201209040-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, Meddings and colleagues (1) report a cross-sectional, statewide analysis of the effect of nonpayment for hospital-acquired catheter-associated urinary tract infection (CAUTI). This work reflects the importance of accurate data as we begin to analyze the financial impact of nonpayment for certain hospital-acquired conditions and the direction of local and national quality improvement initiatives based on those data. Disturbingly, these investigators found that the CAUTI rates determined by using claims data were much lower than epidemiologic surveillance would indicate and seemed to be suspect. Consequently, the financial savings from nonpayment for CAUTI was negligible. The data obtained from ...References1. Meddings JA, Reichert H, Rogers MA, Saint S, Stephansky J, McMahon LF. Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection. A statewide analysis. Ann Intern Med. 2012;157:305-12. LinkGoogle Scholar2. Physician Consortium for Performance Improvement. Work Group Charge. American Medical Association; 2009. Accessed at www.ama-assn.org/resources/doc/cqi/pcpi-work-group-charge.pdf on 29 July 2012. Google Scholar3. National Quality Forum. Measure Evaluation Criteria. January 2011. Accessed at www.qualityforum.org/Measuring_Performance/Submitting_Standards/Measure_Evaluation_Criteria.aspx on 25 July 2012. Google Scholar4. Classen DC, Resar R, Griffin F, Federico F, Frankel T, Kimmel N, et al. “Global trigger tool” shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff (Millwood). 2011;30:581-9. [PMID: 21471476] CrossrefMedlineGoogle Scholar5. Egener B, McDonald W, Rosof B, Gullen D. Perspective: organizational professionalism: relevant competencies and behaviors. Acad Med. 2012;87:668-74. [PMID: 22450182] CrossrefMedlineGoogle Scholar6. ABIM Foundation. ACP—ASIM Foundation. European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136:243-6. [PMID: 11827500] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Bernard Rosof, MDAffiliations: From North Shore-LIJ Health System, Huntington, NY 11743.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1789.Corresponding Author: Bernard Rosof, MD, Huntington Hospital, 270 Park Avenue, Huntington, NY 11743; e-mail, [email protected]. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffect of Nonpayment for Hospital-Acquired, Catheter-Associated Urinary Tract Infection Jennifer A. Meddings , Heidi Reichert , Mary A.M. Rogers , Sanjay Saint , Joe Stephansky , and Laurence F. McMahon Jr. Metrics Cited byComparison Between Clinical Registry and Medicare Claims Data on the Classification of Hospital Quality of Surgical CareElectronic Medical Records and Quality of Cancer Care 4 September 2012Volume 157, Issue 5Page: 379-380KeywordsAdverse eventsHealth careHealth care qualityHealth information technologyMedicareMotivationPerformance measuresQuality improvementSafety ePublished: 4 September 2012 Issue Published: 4 September 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Performance measures (PMs) are specified metrics by which a health-care provider's care can be compared with national benchmarks. The use of PMs is a key component of efforts to improve the quality and value of health care. The National Quality Forum (NQF) is the federally recognized endorser of PMs. From 2006 to 2009, the Quality Improvement Committee (QIC) of the American College of Chest Physicians engaged in the review of proposed PMs as a member of the NQF. This article provides a review of the QIC's experience with PMs and NQF membership and the lessons learned, an overview of the enhancements made to the NQF endorsement process in 2010 and 2011, and a discussion of the next steps that would further strengthen the measure development and endorsement processes and increase the likelihood of measurement leading to better patient outcomes.

“The office is closed at this time and will reopen at 9 am tomorrow morning. If this is an emergency, please call 911 or go to the nearest emergency room.” There has been an important evolution in the practice of medicine in the past decade. An article included in this issue, “Exploring New Intake Models for the Emergency Department,” clearly highlights the emergence of the emergency department (ED) as a primary portal of entry for many patients. Within the context of the issues raised by the authors we must answer the following questions: “Why does the percentage of nonurgent ED visits as a percentage of overall visits continue to rise (ie, 10% in 2002 and 13.9% in 2005)?” “Who uses the ED for nonurgent care?” “Where are the opportunities to reduce ED overuse?” The National Quality Forum’s National Priorities Partnership (NPP) has identified eliminating overuse while ensuring the delivery of appropriate care as one of 6 national priority areas. The NPP envisions health care that promotes better health and more affordable care by continually and safely reducing the burden of unscientific, inappropriate, and excessive care including tests, drugs, procedures, office and hospital visits, and hospital stays. Making overuse a national concern will reduce harm, disparities, disease burden, and waste. Assuring access to appropriate care on a timely basis will also reduce more serious chronic disease consequences downstream. Examples include hypertension, congestive heart failure, and early detection of malignant disease. Potentially preventable ED visits is one of the 9 areas targeted by the overuse committee of the NPP. The Commonwealth Fund 2008 National Scorecard on US performance noted that 26% of adults went to the ED in the previous 2 years for conditions that could have been treated by their regular doctor, if available. The United States fared the worst in a comparison with 6 other countries (Germany, Netherlands, New Zealand, the United Kingdom, Australia, and Canada). Nationally, 60 million, or half of the 120 million annual ED visits, are potentially avoidable. In 2006, there were 119.2 million visits to hospital EDs, 15.9 million of which were considered emergent or urgent. Emergency services are often the only alternative for the uninsured or underinsured as their access to primary care services is limited. However, the New England Healthcare Institute notes that lack of timely appointments and after-hours care also drives patients to the ED. Primary care practices often instruct patients to seek care in the ED. Patients can receive care in the ED anytime—regardless of the severity of their condition—and in view of the wide array of services available in the ED, patients can receive immediate feedback about their condition. These factors contribute to the fact that all payer groups and age groups contribute to the issue of nonurgent care in the ED. This trend applies to Medicare and Medicaid beneficiaries in particular. Insured patients with a primary care alternative also inappropriately use the ED; one third of ED visits are made during regular business hours when primary care offices are open. According to statistics from the Centers for Disease Control and Prevention and the Massachusetts Division of Health Care Financing and Policy, the estimated nonurgent, preventable/avoidable ED visits in Massachusetts in 2006 were made by 22 000 patients with private insurance, 15 000 with Medicaid, 10 000 uninsured, and 9000 Medicare patients. The average cost of an ED visit is $540 more than the cost of an office visit. If we can reduce ED overuse (ie, if all 60 million avoidable ED visits were redirected to a less costly setting), there is an opportunity to improve care and a potential savings of $32 billion. Overuse of nonurgent ED services results in potentially avoidable hospital admissions in 5.5% of cases as well as higher volumes of more expensive testing. The unintended consequences of harm inherent from inappropriate testing, procedures, and hospitalizations have been well documented and affect quality and patient safety. The frequent lack of follow-up on recommendations given to the patient in the ED and poor communication with the primary care physician (if indeed there is one) add to the concerns of poor coordination of care—particularly in the elderly and patients with chronic illnesses—and ED revisits. To ensure quality, safety, and patient satisfaction when the patient arrives in the ED, the recommendations inherent in the Welch and Davidson article in this journal should be carefully reviewed. Timely access to primary care services must be a focus of quality improvement efforts if we