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NQF Disparities Measures Summary

NQF Disparities Measures Summary

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Published by: Ignatius Bau on Aug 31, 2012
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Healthcare Disparities andCultural Competency Measures
Purpose of the Project
Research from the Institute of Medicineshows that racial and ethnic minorities oftenreceive lower quality care than their whitecounterparts, even after controlling for factorssuch as insurance coverage, socioeconomicstatus, and comorbidities.
Such disparities areexacerbated by additional factors. Racial andethnic minorities have poorer health status ingeneral, face more barriers to care, and aremore likely to have poor health literacy.Performance measures that evaluate how andwhy disparities exist are an essential part ofthe e
ort to eliminate health disparities. NQFhas previously endorsed disparities-sensitivemeasures for ambulatory care, in addition toestablishing criteria for evaluating disparities-sensitive measures. In February 2011, NQFbegan a new project – funded by the RobertWood Johnson Foundation – that soughtto expand on its earlier work and establisha more detailed picture of how to approachmeasurement of healthcare disparities acrosssettings and populations.The project began with acommissioned paper that outlined methodological concerns withmeasuring disparities. These include datacollection, the implications of risk adjustmentand stratification, and the unintendedconsequences of public reporting. The paperalso advised revising the original disparities-sensitive evaluation criteria, and identifyingbroader sets of disparities-sensitive measureswithin the NQF portfolio. This paper helpedguide NQF e
orts to endorse a set of relatedperformance measures.
What Was Endorsed
Summary of Healthcare Disparities and CulturalCompetency Project
Measure submitted forconsideration16Measures recommendedfor endorsement12(0 maintenance)Measures notrecommended forendorsement4
 Under the healthcare disparities and culturalcompetency project, NQF endorsed 12measures suitable for accountability andquality improvement. All 12 measures werenew.Measure stewards included a range ofhealthcare stakeholders, including theAmerican Medical Association; the Agencyfor Healthcare Research and Quality; RANDCorporation; and the Department of HealthPolicy at The George Washington University.A full list of measures is available at the end ofthis report.
The Need these Measures Fill
This new set of measures will significantlyadvance quality improvement e
orts toeliminate disparities across the healthcarecommunity. Several measures use surveysfrom the American Medical Association’sCommunication Climate Assessment Toolkit,designed to help improve patient-providerinteraction. In addition, the Agency forHealthcare Research and Quality measures
Healthcare Disparities and Cultural Competency Measures
use the Consumer Assessment of HealthcareProviders and Systems (CAHPS®) Item Set forAddressing Health Literacy to evaluate providercommunications, disease self-management, andcommunication about medicines, test results,and forms. Finally, RAND’s cultural competencyimplementation measure is designed to helphealthcare organizations identify how well theyprovide culturally competent care, serve theneeds of diverse populations, and adhere to 12out of 45 NQF-endorsed cultural competencypractices. All of these measures will be helpful toproviders working to improve care for all patients.
Potential Use
These measures are designed for use by a rangeof clinical settings and providers, physiciano
ces, ambulatory centers, health plans andhospitals.
Project Perspectives
Eliminating healthcare disparities and improvingcultural competency are integral to advancingquality improvement e
orts throughout thehealthcare system. These new measures areeven more significant in that the majority ofthem evaluate patient experience, an increasinglyimportant concern in quality measurementand improvement. When providers directlyengage with patients – whether by holdingconversations in a native language, ensuringpatients understand medication adherence, orestablishing a level of trust throughout treatment– they are better able to deliver high-quality careto vulnerable populations.Throughout the project, NQF identified severalimportant concepts beyond race, ethnicity, andlanguage that future disparities-related measuredevelopment will need to address. These include:
Leadership and accountability
Addressing other populations withknown disparities, such as gender, lowsocioeconomic status, and persons withdisabilities
Health-related quality of life
Inclusion of socioeconomic status variableswithin measure concepts, such as educationlevel or income – particularly as proxies forhealth literacy/beliefs
Tracking the flow of information specificto disparities and culture within healthcarethrough accountable care organizations
Identifying the number of bilingual/biculturalproviders and tracking the number ofqualified/certified medical interpreters andtranslators
Measures using comparative analyses with areference population (ex. percent adherenceof a given measure with the targetedpopulation as a numerator and the referenceor majority population as the denominatorwith serial assessments to demonstrateimprovement to unity)
Measurement of the e
ectiveness of servicesprovided to the patient
Measures related to e
ective engagement ofdiverse communities
Endorsed Measures
1888: Workforce development measure derivedfrom the workforce development domain of theCommunication Climate Assessment Toolkit(CCAT) (American Medical Association)
Site score on the measure domain of“Workforce Development” of the CommunicationClimate Assessment Toolkit (C-CAT), 0-100.
1901: Performance evaluation measure derivedfrom the performance evaluation domain of theCommunication Climate Assessment Toolkit(CCAT) (American Medical Association)
Site score on domain of“performance evaluation” of the CommunicationClimate Assessment Toolkit (C-CAT), 0-100.
1905 Leadership commitment measure derivedfrom the leadership commitment domain of theCommunication Climate Assessment Toolkit(CCAT) (American Medical Association)
Site score on the measure derivedfrom the domain of “Leadership Commitment” ofthe Communication Climate Assessment Toolkit(C-CAT), 0-100.
Healthcare Disparities and Cultural Competency Measures
1892: Individual engagement measure derivedfrom the individual engagement domain of CCAT(American Medical Association)
Site score on “Individuals’Engagement” domain of patient-centeredcommunication, per the Communication ClimateAssessment Toolkit (C-CAT); 0-100.
1894: Cross-cultural communication measurederived from the cross-cultural communicationdomain of the CCAT (American MedicalAssociation)
Site score for “cross-culturalcommunication” domain of CommunicationClimate Assessment Toolkit (C-CAT), 0-100.
1896: Language services measure derivedfrom the language services domain of CCAT(American Medical Association)
Site score on domain of “languageservices” of the Communication ClimateAssessment Toolkit (C-CAT), 0-100.
1898: Health literacy measure derived fromthe health literacy domain of CCAT (AmericanMedical Association)
Site score on the domain of“health literacy” of the Communication ClimateAssessment Toolkit (C-CAT), 0-100.
1902: Clinicians/Groups’ Health LiteracyPractices Based on the CAHPS® Item Set forAddressing Health Literacy (AHRQ)
These measures are based on theCAHPS Item Set for Addressing Health Literacy,a set of supplemental items for the CAHPSClinician & Group Survey. The item set includesthe following domains: Communication withProvider (Doctor), Disease Self-Management,Communication about Medicines, Communicationabout Test Results, and Communication aboutForms. Samples for the survey are drawn fromadults who have had at least one provider´s visitwithin the past year. Measures can be calculatedat the individual clinician level, or at the group(e.g., practice, clinic) level. We have included inthis submission items from the core Clinician/ Group CAHPS instrument that are required forthese supplemental items to be fielded (e.g.,screeners, stratifiers). Two composites can becalculated from the item set:1. Communication to improve health literacy (5items), and2. Communication about medicines (3 items)
1904: Clinician/Group’s Cultural CompetenceBased on the CAHPS® Cultural Competence ItemSet (AHRQ)
These measures are based on theCAHPS Cultural Competence Item Set, a set ofsupplemental items for the CAHPS Clinician/ Group Survey that includes the followingdomains: Patient-provider communication;Complementary and alternative medicine;Experiences of discrimination due to race/ ethnicity, insurance, or language; Experiencesleading to trust or distrust, including level oftrust, caring and confidence in the truthfulnessof their provide; and Linguistic competency(Access to language services). Samples for thesurvey are drawn from adults who have at leastone provider´s visit within the past year. Measurescan be calculated at the individual clinician level,or at the group (e.g., practice, clinic) level. Wehave included in this submission items fromthe Core Clinician/Group CAHPS instrumentthat are required for these supplemental itemsto be fielded (e.g., screeners, stratifiers). Twocomposites can be calculated from the item set:1. Providers are caring and inspire trust (5items), and2. Providers are polite and considerate (3Items).
1821: L2: Patients receiving language servicessupported by qualified language servicesproviders (Department of Health Policy, TheGeorge Washington University)
This measure is used to assess thepercentage of limited English-proficient (LEP)patients receiving both initial assessment anddischarge instructions supported by assessed andtrained interpreters or from bilingual providersand bilingual workers/employees assessed forlanguage proficiency.
1824: L1A: Screening for preferred spokenlanguage for health care (Department of HealthPolicy, The George Washington University)
This measure is used to assess thepercent of patient visits and admissions wherepreferred spoken language for health care isscreened and recorded.

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