scholarly journals Using a stakeholder-engaged approach to develop and validate electronic clinical quality measures

2016 ◽  
Vol 24 (3) ◽  
pp. 503-512
Author(s):  
Jill Boylston Herndon ◽  
Krishna Aravamudhan ◽  
Ronald L Stephenson ◽  
Ryan Brandon ◽  
Jesley Ruff ◽  
...  
Keyword(s):  
Reliability And Validity ◽  
Kappa Statistic ◽  
Quality Measures ◽  
The United States ◽  
National Quality Forum ◽  
Perfect Agreement ◽  
Clinical Quality ◽  
National Quality ◽  
Test Feasibility ◽  
Data Elements

Objective: To describe the stakeholder-engaged processes used to develop, specify, and validate 2 oral health care electronic clinical quality measures. Materials and Methods: A broad range of stakeholders were engaged from conception through testing to develop measures and test feasibility, reliability, and validity following National Quality Forum guidance. We assessed data element feasibility through semistructured interviews with key stakeholders using a National Quality Forum–recommended scorecard. We created test datasets of synthetic patients to test measure implementation feasibility and reliability within and across electronic health record (EHR) systems. We validated implementation with automated reporting of EHR clinical data against manual record reviews, using the kappa statistic. Results: A stakeholder workgroup was formed and guided all development and testing processes. All critical data elements passed feasibility testing. Four test datasets, representing 577 synthetic patients, were developed and implemented within EHR vendors’ software, demonstrating measure implementation feasibility. Measure reliability and validity were established through implementation at clinical practice sites, with kappa statistic values in the “almost perfect” agreement range of 0.80–0.99 for all but 1 measure component, which demonstrated “substantial” agreement. The 2 validated measures were published in the United States Health Information Knowledgebase. Conclusion: The stakeholder-engaged processes used in this study facilitated a successful measure development and testing cycle. Engaging stakeholders early and throughout development and testing promotes early identification of and attention to potential threats to feasibility, reliability, and validity, thereby averting significant resource investments that are unlikely to be fruitful.

scholarly journals Completeness, accuracy, and computability of National Quality Forum-specified eMeasures

2014 ◽  
Vol 22 (2) ◽  
pp. 409-416 ◽  
Author(s):  
Andy Amster ◽  
Joseph Jentzsch ◽  
Ham Pasupuleti ◽  
K G Subramanian
Keyword(s):  
Data Availability ◽  
Data Mapping ◽  
Data Element ◽  
Clinical Practices ◽  
National Quality Forum ◽  
Post Discharge ◽  
Data Set ◽  
Clinical Text ◽  
National Quality ◽  
Data Elements

Abstract Objective To analyze the completeness, computability, and accuracy of specifications for five National Quality Forum-specified (NQF) eMeasures spanning ambulatory, post-discharge, and emergency care within a comprehensive, integrated electronic health record (EHR) environment. Materials and methods To evaluate completeness, we assessed eMeasure logic, data elements, and value sets. To evaluate computability, we assessed the translation of eMeasure algorithms to programmable logic constructs and the availability of EHR data elements to implement specified data criteria, using a de-identified clinical data set from Kaiser Permanente Northwest. To assess accuracy, we compared eMeasure results with those obtained independently by existing audited chart abstraction methods used for external and internal reporting. Results One measure specification was incomplete; missing applicable LOINC codes rendered it non-computable. For three of four computable measures, data availability issues occurred; the literal specification guidance for a data element differed from the physical implementation of the data element in the EHR. In two cases, cross-referencing specified data elements to EHR equivalents allowed variably accurate measure computation. Substantial data availability issues occurred for one of the four computable measures, producing highly inaccurate results. Discussion Existing clinical workflows, documentation, and coding in the EHR were significant barriers to implementing eMeasures as specified. Implementation requires redesigning business or clinical practices and, for one measure, systemic EHR modifications, including clinical text search capabilities. Conclusions Five NQF eMeasures fell short of being machine-consumable specifications. Both clinical domain and technological expertise are required to implement manually intensive steps from data mapping to text mining to EHR-specific eMeasure implementation.

scholarly journals Igniting Harmonized Digital Clinical Quality Measurement through Terminology, CQL, and FHIR

2020 ◽  
Vol 11 (01) ◽  
pp. 023-033
Author(s):  
Robert C. McClure ◽  
Caroline L. Macumber ◽  
Julia L. Skapik ◽  
Anne Marie Smith
Keyword(s):  
Care Delivery ◽  
Quality Measurement ◽  
Quality Measures ◽  
Data Representation ◽  
Evidence Based ◽  
Data Mapping ◽  
Local Data ◽  
Clinical Quality ◽  
Care Gaps ◽  
Data Elements

Abstract Background Electronic clinical quality measures (eCQMs) seek to quantify the adherence of health care to evidence-based standards. This requires a high level of consistency to reduce the effort of data collection and ensure comparisons are valid. Yet, there is considerable variability in local data capture, in the use of data standards and in implemented documentation processes, so organizations struggle to implement quality measures and extract data reliably for comparison across patients, providers, and systems. Objective In this paper, we discuss opportunities for harmonization within and across eCQMs; specifically, at the level of the measure concept, the logical clauses or phrases, the data elements, and the codes and value sets. Methods The authors, experts in measure development, quality assurance, standards and implementation, reviewed measure structure and content to describe the state of the art for measure analysis and harmonization. Our review resulted in the identification of four measure component levels for harmonization. We provide examples for harmonization of each of the four measure components based on experience with current quality measurement programs including the Centers for Medicare and Medicaid Services eCQM programs. Results In general, there are significant issues with lack of harmonization across measure concepts, logical phrases, and data elements. This magnifies implementation problems, confuses users, and requires more elaborate data mapping and maintenance. Conclusion Comparisons using semantically equivalent data are needed to accurately measure performance and reduce workflow interruptions with the aim of reducing evidence-based care gaps. It comes as no surprise that electronic health record designed for purposes other than quality improvement and used within a fragmented care delivery system would benefit greatly from common data representation, measure harmony, and consistency. We suggest that by enabling measure authors and implementers to deliver consistent electronic quality measure content in four key areas; the industry can improve quality measurement.

scholarly journals Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242844
Author(s):  
Nadereh Pourat ◽  
Xiao Chen ◽  
Connie Lu ◽  
Weihao Zhou ◽  
Hank Hoang ◽  
...  
Keyword(s):  
United States ◽  
Low Income ◽  
Rural Areas ◽  
Health Resources ◽  
Quality Measures ◽  
The United States ◽  
Health Centers ◽  
Quality Performance ◽  
Clinical Quality

Background In the United States, there are nearly 1,400 Health Resources and Services Administration-funded health centers (HCs) serving low-income and underserved populations and more than 600 of these HCs are located in rural areas. Disparities in quality of medical care in urban vs. rural areas exist but data on such differences between urban and rural HCs is limited in the literature. We examined whether urban and rural HCs differed in their performance on clinical quality measures before and after controlling for patient, organizational, and contextual characteristics. Methods and findings We used the 2017 Uniform Data System to examine performance on clinical quality measures between urban and rural HCs (n = 1,373). We used generalized linear regression models with the logit link function and binomial distribution, controlling for confounding factors. After adjusting for potential confounders, we found on par performance between urban and rural HCs in all but one clinical quality measure. Rural HCs had lower rates of linking patients newly diagnosed with HIV to care (74% [95% CI: 69%, 80%] vs. 83% [95% CI: 80%, 86%]). We identified control variables that systematically accounted for eliminating urban vs. rural differences in performance on clinical quality measures. We also found that both urban and rural HCs had some clinical quality performance measures that were lower than available national benchmarks. Main limitations included potential discrepancy of urban or rural designation across all HC sites within a HC organization. Conclusions Findings highlight HCs’ contributions in addressing rural disparities in quality of care and identify opportunities for improvement. Performance in both rural and urban HCs may be improved by supporting programs that increase the availability of providers, training, and provision of technical resources.

Assessment and Stratification of High-Impact Data Elements in Electronic Clinical Quality Measures: A Joint Data Quality Initiative Between CancerLinQ® and Cancer Treatment Centers of America

2018 ◽  
pp. 1-10
Author(s):  
Rory J. Lettvin ◽  
Alpna Wayal ◽  
Amy McNutt ◽  
Robert S. Miller ◽  
Robert Hauser
Keyword(s):  
Data Quality ◽  
Cancer Treatment ◽  
Quality Measures ◽  
Potential Effect ◽  
High Impact ◽  
Specific Data ◽  
Clinical Quality ◽  
Data Elements ◽  
Clinical Measures ◽  
Impact Data

Purpose A joint data quality initiative between the Cancer Treatment Centers of America and the ASCO big data health technology platform CancerLinQ® was initiated to document and codify the steps taken to evaluate, stratify, and determine the potential effect of data elements used for electronic clinical quality measures as captured within structured fields in electronic health records. Methods The processes involved the identification of clinical concepts required in measure population criteria and then to map these to the corresponding components of the CancerLinQ data model. A quantitative assessment of mappings between electronic clinical quality measure clinical concepts and attributes from the CancerLinQ clinical database was performed. In parallel, a qualitative analysis of high-impact data elements from the Cancer Treatment Centers of America clinical measures was made using local, expert consensus. Results An impact assessment was derived using a count of the data elements across measures and the specific population criteria affected. Conclusion A list of putative high-impact data elements can provide guidance for clinicians to facilitate specific data element capture related to quality metrics in an electronic environment.

Using Registry Data to Support National Quality Forum Endorsement of Quality Measures for Home-Based Medical Care

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Gregory Foakes ◽  
Courtney Hurt ◽  
Jamie L. Lehner ◽  
Heather Tinsley ◽  
Joan Valentine ◽  
...  
Keyword(s):  
Medical Care ◽  
Quality Measures ◽  
Registry Data ◽  
National Quality Forum ◽  
Home Based ◽  
National Quality

Don't Fear Clinical Quality Measures

2012 ◽  
Vol 42 (11) ◽  
pp. 51
Author(s):  
CHRISTOPHER NOTTE ◽  
NEIL SKOLNIK
Keyword(s):  
Quality Measures ◽  
Clinical Quality

Validity of puberty self-report in children and adolescents in Ho Chi Minh City

MedPharmRes ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 33-37
Author(s):  
Tam M. Do ◽  
Thanh K. Van ◽  
Huyen TT. Bich ◽  
Thanh TK. Tran ◽  
Minh X. Ngo ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Sexual Maturation ◽  
Kappa Statistic ◽  
Community Context ◽  
Self Report ◽  
Ho Chi Minh City ◽  
Pubertal Stage ◽  
Perfect Agreement ◽  
Kendall’S Τ ◽  
High Concordance

Background: Puberty is a milestone in child and adolescent development, yet a feasible tool to accurately assess pubertal stage in community context has not been validated in Vietnam. Aim: This study was conducted to validate pubertal self-report among Ho Chi Minh City children and adolescents in comparison with paediatrician’s assessment. Methods: 80 girls and 76 boys aged from 6 to 17 years old from 5 schools in Ho Chi Minh City were recruited. Self-administered questionnaires about sexual maturation were distributed to participants and results were compared with physician’s pubertal examination. Kappa statistic and Kendall’s τ b were used to evaluate validity of the questionnaire. Results: Boys tended to overestimate their development stages while girls tended to underestimate. Fair to almost perfect agreement between students’ reports and paediatricians’ evaluation, along with high concordance was recorded, however younger boys (aged 6-11) showed limited evaluation of their own sexual maturation. Conclusion: This method was inaccurate to evaluate younger boys’ sexual maturation; however, acceptable accuracy in sexual maturation estimation among younger girls and adolescents could allow it to serve as an effective screening tool in community context.

The Portuguese Performance Assessment of Self-Care Skills Measure: Validity and Reliability

2021 ◽  
pp. 153944922110213
Author(s):  
Pedro L. Ferreira ◽  
Ana L. Simões ◽  
Marília Dourado ◽  
Margo B. Holm ◽  
Joan C. Rogers
Keyword(s):  
Performance Assessment ◽  
Self Care ◽  
The United States ◽  
Factor Analyses ◽  
Validity And Reliability ◽  
Portuguese Population ◽  
Perfect Agreement ◽  
Portuguese Version ◽  
And Gender ◽  
Effective Assessment

Performance Assessment of Self-Care Skills (PASS) is a performance-based scale developed in the United States. Because of cultural differences, a Portuguese version was developed, then validated in the Portuguese population and tested ensuring reliability. The objective of this study was to create and test psychometric properties of a Portuguese version of PASS. A linguistic validation on older adults with physical/cognitive disabilities enabled us to validate P-PASS. Some original tasks were changed. Data were analyzed by PASS constructs (independence-safety adequacy), age, and gender. Construct validity (known-group analyses, factor analyses), with 98 individuals yielded excellent results. Reliability between two observers for 30 participants yielded almost perfect agreement for all three constructs. Independence scores were highest, followed by safety and adequacy. Men presented greater independence, as well as participants <60 years. We obtained results comparable with the original version. Conclusion. P-PASS is valid and reliable for the Portuguese population, enabling effective assessment of function and measurement of health outcomes.

Translation and Validation of the Brazilian Portuguese Version of the Broad Conceptualization of Beauty Scale With Brazilian Women

2021 ◽  
pp. 036168432110134
Author(s):  
Alessandra Costa Pereira Junqueira ◽  
Tracy L. Tylka ◽  
Sebastião de Sousa Almeida ◽  
Telma Maria Braga Costa ◽  
Maria Fernanda Laus
Keyword(s):  
Factor Structure ◽  
Reliability And Validity ◽  
Well Being ◽  
The United States ◽  
Brazilian Portuguese ◽  
Incremental Validity ◽  
Body Appreciation ◽  
Two Factors ◽  
Body Sizes ◽  
Definition Of

In many countries, women are socialized to adopt a narrow definition of beauty. Research has revealed that, in the United States and China, the ability to broadly conceptualize beauty (perceive beauty in diverse body sizes, shapes, and appearances) is linked to women’s lower anti-fat attitudes, higher body appreciation, and higher well-being. In this study, we translated an existing measure of this construct, the Broad Conceptualization of Beauty Scale (BCBS), into Brazilian Portuguese and evaluated the factor structure and reliability and validity of its scores with a diverse sample of 563 Portuguese women. Findings revealed that the Brazilian Portuguese BCBS contains two factors—external/appearance features of beauty (BCBS-E) and internal features of beauty (BCBS-I)—contrary to the unidimensional factor structure found in previous studies. Support for internal consistency and 3-week test–retest reliability was garnered. Total BCBS and BCBS-E scores evidenced convergent, discriminant, and incremental validity, whereas the BCBS-I did not accrue substantial convergent or incremental validity support beyond its inverse bivariate association with anti-fat attitudes. We recommend the use of the Brazilian Portuguese BCBS in body image research programs as well as clinical practice and prevention programs with Brazilian women seeking support for body dissatisfaction and disordered eating.

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