National Organizations & Initiatives
AQA (formerly Ambulatory Care Quality Alliance)
The AQA is an alliance of physician organizations, consumers, insurance plans, payers and government agencies whose mission is to come to a consensus on a common national strategy for physician-level performance measurement, data aggregation and performance reporting. To promote consistent measurement and decrease the burden to physicians of multiple, overlapping measures from numerous measurement programs, the AQA endorsed a “starter set” of 26 primary care measures, including 2 antidepressant medication management measures. The AQA has also developed principles in several areas, including: endorsing specialty measure sets; generating principles for the use of clinical data registries for performance measurement; principles for “efficiency” measures; principles for “appropriateness” measures; identifying disorders for the development of “cost of care” measures; and endorsing the A-CAHPS instrument for measuring patient experience of care. With assistance from AHRQ (Agency for Healthcare Research and Quality) and CMS (Centers for Medicare & Medicaid Services), the AQA is supporting 6 pilot efforts (Better Quality Information to Improve Care for Medicare Beneficiaries (BQI) Project) around the country to test its endorsed measures and measurement principles, to aggregate performance data from multiple sources, and test performance reporting.
APA has been a member of AQA since fall 2005. APA staff participates in the conference calls of the Performance Measurement Workgroup, and attends tri-annual AQA meetings. APA staff keeps the APA Committee on Quality Indicators apprised of activities and work products of the AQA and solicits input during document development and when documents are reviewed for AQA endorsement.
Hospital-Based Inpatient Psychiatric Services (HBIPS) Core Measure Set
Joint Commission
The Joint Commission is currently beta-testing five “core measures” for hospital-based inpatient psychiatric services. Up until now, psychiatric hospitals have reported on self-selected measures. It is anticipated that introducing a core measure set for accreditation will provide data that can be used at a national level of analysis to identify problem areas, demonstrate quality improvement, and identify other trends. The topics of the five measures are: assessment of risk, substance abuse, trauma and patient strengths completed; hours of restraint use; hours of seclusion use; patients discharged on multiple antipsychotic medications [emphasis is documenting adequate clinical rationale for polypharmacy]; and discharge assessment and aftercare recommendations are provided to community health providers upon discharge.
The APA has been in a partnership with the Joint Commission, National Association of Psychiatric Health Systems (NAPHS), National Association of State Mental Health Program Directors (NASMHPD), and the NASMHPD Research, Inc. to develop the “core measures.” It is anticipated that these measures will be finalized by late 2008.
National Quality Forum (NQF)
The mission of the NQF is to improve American healthcare through endorsement of consensus-based national standards for measurement and public reporting of healthcare performance data that provide meaningful information about whether care is safe, timely, beneficial, patient-centered, equitable and efficient. NQF is recognized by Congress, which requires that measures used in federal programs must be NQF endorsed.
APA is a voting member of NQF through APIRE (American Psychiatric Institute for Research and Education). Ballots containing measures or issues with potential significance to psychiatry are circulated to the APA Committee on Quality Indicators. A set of ambulatory measures, including measures on MDD, ADHD, Bipolar Disorder, and SUD were endorsed by NQF in December 2006. Several APA members serve on NQF Technical Advisory Panels and Steering Committees.
Physician Consortium for Performance Improvement (PCPI)
Convened by the American Medical Association (AMA)
The Consortium includes physician and methodologist representatives from a variety of healthcare stakeholders. PCPI engages physicians to develop physician-level, evidence-based, condition-centered clinical performance measures and outcomes reporting tools. As one of the 6 largest physician organizations, APA has a seat on the Executive Committee of the PCPI, currently held by John Oldham, M.D.
APA was involved in the development of the adult MDD measure set, and is involved in the adolescent/child MDD measure set and substance use disorder measure set, both currently under development.
Physician Quality Reporting Initiative (PQRI)
Centers for Medicare & Medicaid Services (CMS)
The PQRI is a voluntary, physician-level performance reporting program of CMS. The program currently includes 3 measures on major depressive disorder. Participants in this program have the opportunity to receive an incentive of up to 1.5% of their Medicare claims. More on PQRI and information for psychiatrists can be found on the APA PQRI page.