The Opportunity
Emergency physicians are playing an increasingly important
role in the delivery of acute, unscheduled care, with approximately one-quarter
of all acute care visits in the U.S. take place in hospital emergency
departments (ED). The majority of ED care is based on diagnosing and treating a
patient’s chief complaint rather than the treating of a specific disease or
condition, because patients present to the ED with chief complaints rather than
definitive diagnoses. In the ED, a patient’s chief complaint describes their
most significant symptoms or signs of illness (e.g. chest pain, headache,
fever, abdominal pain, etc.) that caused him or her to seek health care.
Current measurement approaches are primarily based on
discharge diagnoses, and do not address the variability in practice required to
establish the diagnosis from a chief-complaint. Moreover, there is a lack of
standard nomenclature to define how chief-complaints are organized,
categorized, and assigned. In addition, a reliance on diagnosis-based
administrative claims for quality measurement creates barriers to establishing valid
and reliable patient groups. Currently, there is no national guidance to
overcome these barriers to use chief complaints in quality measurement for
patients presenting to the ED.
About the Project
NQF will convene a multi-stakeholder committee to direct an
environmental scan of chief-complaint-based measures and concepts, data
sources, and approaches to standardizing nomenclature focused for documenting chief complaints. The committee will also
assess the strengths and weaknesses of potential data sources to describe chief
complaints. The scan, which will inform the development of a conceptual
framework and other recommendations for chief complaint-based quality
measurement.
Objectives
The Committee will:
- Provide guidance on the environmental scan for measures of chief
complaint diagnosis
- Identify measurement gaps
- Develop a conceptual framework, addressing issues such as data
source suitability and standardized nomenclature
NQF Process
Over a 12 month period of performance, NQF will conduct an
environmental scan to identify measures and gaps, and develop a framework to
measure related to the diagnosis of chief complaints. A multistakeholder
committee of experts will provide input on the environmental scan and
framework, using relevant elements of the NQF’s Consensus Development process
to receive and review comments; however, the process will not involve voting or
the endorsement of any product. Throughout this project, NQF will solicit input
from the Committee, including NQF membership and public stakeholders at key
points in the project.
Funding
This project is funded under a contract with the Department of Health
and Human Services. For information about the availability of auxiliary aids
and services for NQF’s federally funded projects, please visit http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html
Related NQF Work
Contact
Information
For more information, please contact Jean-Luc Tilly at
202.783.1300 or via email at chiefcomplaint@qualityforum.org.