NQF seeks measures for reporting of infections

Officials cite volume of infections

The Washington, DC-based National Quality Forum (NQF) has undertaken a project to seek consensus on a set of national performance measures for public reporting of health care-associated infections. The NQF has solicited measures for review, evaluation, and potential inclusion in the final set of voluntary national measures and, as of this writing, just completed the collection of all proposed measures.

Measures are being considered at a number of levels of analysis, including individual physicians, physician offices, physician groups, health care institutions including but not limited to hospitals and nursing homes, health plans, and community- or population-level measures. To be included as part of the initial evaluation, proposed measures had to be fully developed for use (e.g., research and testing have been completed) and be applicable to health care-associated infections.

"HAIs [healthcare-associated infections] represent an important public health issue," says Merilyn D. Francis, RN, MTP, vice president of NQF. "Approximately 90,000 patients in the U.S. die from an HAI every year out of the estimated 2 million who contract one, and it is estimated that at least 20%-30% are preventable."

In addition, she notes, the NQF has made patient safety a primary issue for a number of years, including the publication of "Safe Practices for Hospital Use to Reduce Infections."

Seeking standardization

"One of the missions of the NQF is to help standardize the way quality of performance is measured and reported," Francis continues. "If you have several people measuring the same thing but in different ways you can’t make valid comparison across entities. That’s where we come in; we don’t develop measures, but we do call for measures. We will evaluate [the proposals] at the staff level for rigor and for how they fit and will also use technical advisory panels and a steering committee."

The main objective, Francis explains, is to discover the "best in class" in terms of performance measures, so that like entities can compare themselves in a way that is fair and balanced. "We try to cut through some of the noise," she notes, "which is very important when it comes to benchmarking. What we’re looking for is a national standard for reporting health care HAI rates and outcomes of interventions."

The proposed measures were solicited in several different categories:

  • intravascular catheters and bloodstream infections and surgically implanted devices;
  • in-dwelling catheters and urinary tract infections;
  • respiratory infections, including those associated with ventilators;
  • surgical-site infections;
  • pediatric infections;
  • reporting and implementation.

"The first four areas are the ones that are most common in terms of HAIs," Francis observes, adding that they are not listed in any specific order of frequency. "The reason we added pediatrics is that some of these patients are a little different than adults; they have a tendency to have more gastrointestinal infections, and they are susceptible to certain types of viruses from the nursery that don’t go to adults."

Year-long review

As for reporting and implementation, she adds the following: "One of the issues with reporting is that several states are making the reporting of these infections mandatory and several others are thinking about it," Francis shares. "This advisory panel [each category has its own advisory panel] will think about what is the best way of reporting to make the information most useful to consumers and lessons learned from states that have implemented them."

There is approximately a year-long review process ahead of the NQF, says Francis. "We will run the proposed measures through for consensus, and then send them out for review and comment," she declares. "Once the board endorses them, we will have a set of voluntary standards." The project is due to be fully completed by mid-2007, she says.

Such a standard will benefit quality managers because "instead of having to create their own standards there will be a place to get them [the NQF web site, www.qualityforum.org]. They will be posted on the site and made more broadly available through a formal report. Also, because of the consensus process we use, Medicare and Medicaid programs can use them as well," she says.

She adds that the new standards also will be beneficial for organizations with several product lines, because they will be able to use the same measures across all of them.

NQF recently joined forces with the National Committee for Quality Health Care (NCQHC), an organization of health industry leaders focused on improving quality, to establish a reconstituted organization, the National Quality Forum.

Under the direction of the board and new CEO and president Janet M. Corrigan, PhD, MBA, key programs of the NQF and the NCQHC will be enhanced, and strategic alliances with other organizations will be pursued to bring more alignment and coordination to the quality movement.

For more information, contact:

Merilyn D. Francis, RN, MTP, Vice President, National Quality Forum, 601 Thirteenth Street, NW, Suite 500 North, Washington, DC 20005. Phone: (202) 783-1300.