- The National Quality Forum's Measure Applications Partnership workgroup has identified a core set of 20 quality measures to address the healthcare needs of rural populations, including access to care.
- The measures have certain qualities in common that make them relevant to rural communities, NQF says in a report released Monday. They are cross-cutting, resistant to low case volume and address the quality and coordination of transitions in care for high-acuity patients.
- The workgroup also identified seven ambulatory care measures that are specified and endorsed for integrated delivery systems and health plans.
In choosing measures, the workgroup focused on ensuring rural providers are fairly assessed. For example, while it was agreed that measuring access to care is important, members felt providers shouldn't be penalized for factors beyond their control, such as longer wait times associated with patient transfers. The workgroup also noted a lack of measures specific to telehealth as a care delivery option.
The workgroup also identified measurement gaps related to cost of care, outcomes and substance use, particularly those having to do with alcohol and opioids.
More than 59 million Americans live in rural areas, often with little or no easy access to healthcare. Data repeatedly show rural populations have poorer overall health than nonrural populations, including higher rates of chronic conditions such as high blood pressure and diabetes.
CMS tasked NQF with establishing the work group in 2017 to advise on challenges facing rural health providers. The report calls for continued funding to permit monitoring and updating of the core measures, as well as discussion of unintended consequences.
Next steps could include identifying a list of optional measures relevant to rural providers, targeting post-acute care issues and continuing to explore ways to improve and measure access to care, according to the report.
Of the 20 core measures identified in the new report, nine are for hospital settings and 11 are for ambulatory settings. The hospital measures address issues such as falls with injury, caesarean birth, alcohol use screening, C-difficile infection, urinary tract infection, emergency transfer communications and hospital-wide all-cause unplanned readmissions.
On the ambulatory side, measures include screening for tobacco use and influenza immunization, comprehensive diabetes care, post-discharge medication reconciliation and advance care planning. Also included are preventive care, screening and follow-up for conditions like obesity, depression and substance use.
The seven additional ambulatory setting measures focus on hypertension, childhood obesity, cervical, colorectal and breast cancer screenings, childhood immunization status and contraception.