Measures Sample gaps, barriers, & challenges
**0557-0558 NQF Endorsed: Patients discharged from a hospital- based inpatient psychiatric setting with a continuing care plan created/ provided to the next level of care clinician or entity.
• Does not include patient perspective in creation of care plan; does not take into account that not all discharged patients may not need care plan • Only gauges whether or not care plan exists – not
what it is composed of and to what extent it is referenced
**CAHPS NQF Endorsed
(NQMC:000849, ECHO® Survey 3.0 Adult Questionnaire): Behavioral health care patients’
experiences: percentage of adult patients who reported whether someone talked to them about including family or friends in their counseling or treatment.
• Does not include Medicare (only commercial and Medicaid members) and only includes those in an MCO or MBHO
• Not available at the provider level
**CAHPS NQF Endorsed
(NQMC:000843, ECHO® Survey 3.0 Adult Questionnaire): Behavioral health care patients’ experiences: percentage of adult patients who rated how much improvement they perceived in themselves.
• Includes behavioral health patients – large group of duals. But denominator only includes those in an MCO or MBHO
• Patients’ perceived improvement – but does not necessarily imply existence of care plan that outlines goals
**CAHPS NQF Endorsed (NQMC:006293, CAHPS® Health Plan Survey 4.0H, Adult Questionnaire): Health plan members’ experiences: percentage of adult health plan members who reported whether a doctor or other health provider included them in shared decision making
• Only includes those in MCO – limited population • Not available at the provider level or for specific
settings
**CAHPS NQF Endorsed (NQMC:004536, CAHPS® Health Plan Survey 4.0, Adult Questionnaire): Health plan members’ satisfaction with care: adult health plan members’ overall ratings of their health care.
• Purely based on 1 to 10 rating of general care received. Lacking in specific areas of care (i.e. individualized care planning) that would really indicate the nature of satisfaction with care
• Only includes those in MCO – limited population • Not available at the provider level or for specific
settings PSS-HIV (NQMC:002046): HIV ambulatory care
satisfaction: percentage of HIV positive adolescent and adult patients who reported how often their case manager went over their service plan and updated it with them every 3 months.
• Limited to one setting (ambulatory) for one patient population (HIV)
• Worthwhile to couple measure with measure gauging contents and “meaningfulness” of service plan
PSS-HIV (NQMC:002046): HIV ambulatory care satisfaction: percentage of HIV positive adolescent and adult patients who reported how often they wanted to be more involved in making decisions about their service plan and goals.
• Limited to one setting (ambulatory) for one patient population (HIV)
Measures Sample gaps, barriers, & challenges
PSS-HIV (NQMC:002077): HIV ambulatory care satisfaction: percentage of HIV positive adult patients who reported whether their substance use counselors helped them to achieve their substance use treatment plan goals.
• Concept of measure is important – but is limited to one patient population in one setting.
• Measure could be coupled with existence of “meaningful” care plan that is includes goals of individual
Non-U.S., Ministry of Health, Spain (NQMC:004978, AHRQ Clearinghouse) End-of-life care: percentage of healthcare professionals who affirm that in their unit or area enquiries are always made about terminal patients’ preferences regarding life-support procedures and treatment.
• Limited to one provider’s perspective – process measure as opposed to experience measure. But concept of including documentation of inquiries around end-of-life preferences in individualized care plan is important
• Measure limited to “terminal patients” – in ideal world, would extend beyond that population to include advanced care planning
• Non-U.S. measure Non-U.S., British Medical Association (NQMC:005100,
AHRQ Clearinghouse): Mental health: the percentage of patients on the mental health register who have a comprehensive care plan documented in the records agreed between individuals, their family and/or carers as appropriate.
• Sentiment of measure is important (existence of care plan agreed upon by individual/family/caregiver) • U.S. has no mental health register. Emphasizes
importance of first having a designated patient population in need of care plan before developing a measure gauging extent of care plans’ existence • Does not include patient perspective
• Only measures the existence of care plan – not its component parts or the extent to which it is followed • Non-U.S. measure
COMMENTS
• Ideally, a measure set for this area would gauge consumer satisfaction with cross-setting care and/or of the care plan (if needed) to meet quality of life and quality of service needs • To have measures that include goal planning
documented in care plan, one must first identify population in need of care plan. • Such measures run the risk of providers simply
checking off the box rather than developing meaningful care plans. Important to have consumer perspective to reflect extent to which individual feels care needs are being met. • Importance of including “goal-oriented
planning” because personal desires/goals may be different from what physician deems “clinically correct” or “appropriate.” Such goals and priorities may be driven by healthy literacy of patient, circumstances of patient/family/
caregiver, patient’s age and medical and home conditions
• “When we sit down to develop participant-
centered plan with goals, we think of what’s important with this person’s life – and it’s not necessarily medical at all. It may have to do with establishing meaning in life – and we don’t have much to assess.”
• “There are ways I look at care plans to see they
are multidimensional ... The broad domains are medical, social, functional, and nutritional.”
• “I’m looking to see that it’s member-centered, it
identifies patient goals, and then I want to see some reflection of interdisciplinary medication, problem solving – contributions from multiple disciplines… And the participant signs off on it. That’s the real work of interdisciplinary care.”