The Opportunity

Despite the widespread use of healthcare measures in the past two decades, many areas of health and healthcare still do not have enough or the right kinds of measures to provide the information needed to drive improvement. Examples of “gap areas” include palliative and end-of-life care, diagnostic accuracy, behavioral health, and care of people with Alzheimer’s disease or multiple chronic conditions. There are also not enough measures of patient-reported outcomes.

The NQF Measure Incubator worked to address these important gaps by facilitating an improved measure development process. Similar to incubators that nurture entrepreneurs in technology environments, the NQF Measure Incubator was designed to nurture development of needed measures by connecting groups interested in particular measure concepts with measure development experts, financial and technical resources, and data. In leading the Measure Incubator®, NQF’s role was to facilitate the work of others. NQF itself did not develop measures.

About the Project

Completed Measure Incubator projects include:

• Food insecurity measure development and testing (PDF), which aims to develop and test three measures: 1) screening 2) appropriate clinical action and 3) change in food insecurity. This Measure Incubator project is supported by Humana.
• Outcome measures to assess survival rates for individuals with lung cancer and a lung cancer PRO-PM (PDF), made possible with support from Bristol-Myers Squibb.
• Outcome measures to assess survival rates for individuals with melanoma (PDF) made possible with support from Bristol-Myers Squibb.
• Patient-reported outcomes for advanced prostate cancer (PDF), with support from Johnson & Johnson Health Care Systems, Inc. (JJHCS). An Expert Panel identified a mix of patient- and caregiver-reported measures and process measures.
• Early detection and patient- and caregiver-centered care for early-stage Alzheimer’s disease (PDF), with support from Genentech, Inc. An Expert Panel identified measure concepts focused on integrating routine screening for and assessment of cognitive impairment and caregiver engagement within clinical practice.
• A collaboration with Integrated Health Association to develop and pilot a benchmarking framework (PDF) for California ACOs that could serve as a national model.
• Preventing C. difficile infections in the community (PDF) strategy session, with support from Pfizer Inc. An Expert Panel identified a suite of measure concepts and prioritized measures focusing on antibiotic stewardship, improving treatment, improving diagnosis and testing, and patient education/experience.
• Work with MN Community Measurement to develop and test a chronic obstructive pulmonary disease (COPD) PRO-PM (PDF). The Measure Incubator received funding from GlaxoSmithKline to support this project.
• Hospice and palliative care person-centered measurement, funded by Compassus. An Expert Panel identified a roadmap for developing PRO-PMs for hospice and palliative care.
• Symptom control and opioid use in patients with inflammatory bowel disease (IBD) (PDF), with support from Johnson & Johnson Health Care Systems, Inc. (JJHCS). An Expert Panel identified measure concepts focus on integrating routine assessments of quality of life and patient engagement within clinical practice, evidence-based care, and inappropriate use of opioids.
• Learning Collaborative: NQF’s Learning Collaborative is a forum of diverse stakeholder organizations that are united in their commitment to improve measure development. See previous work here.
• Timely and appropriate biomarker screening and treatment for common genetic mutations in non-small cell lung cancer (NSCLC) (PDF), with support from Genentech, Inc. An Expert Panel identified measure concepts that span the continuum of care—from biopsy through treatment—and assess the role of medical oncologists, pathologists, and laboratories in ensuring that patients receive evidence-based diagnosis and care.
• Appropriate care and chronic disease management for Lupus (PDF) with support from Johnson & Johnson Health Care Systems, Inc (JJHCS). An Expert Panel identified a suite of measure concepts that focus on improving Lupus health outcomes and patient quality of life.
• Initial development of a multiple sclerosis (MS) performance measure (PDF) focused on patient-reported outcomes in the clinical setting, with funding from Biogen. An Expert Panel recommended development of a performance measure assessing the use of an MS-specific PRO measure (PROM) in clinical care.
• Nonvalvular atrial fibrillation (NVAF)-related stroke prevention (PDF) strategy session, with financial support from Bristol Myers Squibb – Pfizer Alliance and Johnson & Johnson Health Care Systems, Inc (JJHCS). An Expert Panel identified a suite of measure concepts and prioritized measures focusing on screening for health literacy, extended cardiac monitoring following cryptogenic stroke, anticoagulation dosing, anticoagulation prescribing in primary care, shared decision making, and stroke outcome.
• Performance measures of serial body mass index and shared decision-making for patients with obesity (PDF), with funding from NovoNordisk.
• Work with Pharmacy Quality Alliance (PQA) and National Health Council (NHC), with funding from Merck & Co., Inc., to create a rubric for assessing patient engagement in quality measurement (PDF).
• Work with PatientsLikeMe®, with funding from the Robert Wood Johnson Foundation, to test a novel approach to gather broad patient input in developing PRO-PMs (PDF).
• Pain management in acute care settings, funded by Mallinckrodt. An Expert Panel identified measure concepts for pain management in the perioperative setting, including concepts focused on opioid use.
• Tools and measure concepts focused on pain management in surgical settings, with support from Heron Therapeutics, Inc. An Expert Panel identified measure concepts that focus on pain management and prevention and management of opioid use disorder and adverse events.
• Postoperative Delirium (POD) Measures (PDF), with financial support from Medtronic. An Expert Panel identified a suite of measure concepts focused on preventing and mitigating POD.
• Work with AARP and OptumLabs to select novel measure development and/or testing proposals for AARP’s 2017 Quality Measures Innovation Grant program. Two awards were issued: (1) PQA, in collaboration with the University of Maryland, proposed a patient safety and outcome measure for people with diabetes; and (2) Tufts Medical Center, in collaboration with Memorial Sloan Kettering Cancer Center and Dana-Farber Cancer Institute, proposed a patient safety measure for treating cancer patients.
• Work with AARP and OptumLabs to select novel measure development and/or testing proposals for AARP’s 2019 Quality Measures Innovation Grant program. Two awards were issued: (1) National Kidney Foundation, in collaboration with AMGA, National Committee for Quality Assurance, PCPI, and the University of California San Francisco, proposed a performance measure to evaluate kidney health in adults with diabetes mellitus; and, (2) Johns Hopkins Armstrong Institute for Patient Safety and Quality proposed to measure stroke misdiagnosis in hospital emergency rooms.
• Outcome measures for rheumatoid arthritis (RA), including a measure focused on treat-to-target approaches and a PRO-PM (PDF), made possible with support from Bristol-Myers Squibb.
• Social determinants of health, particularly food insecurity (PDF), with support from the Aetna Foundation. An Expert Panel identified a suite of measure concepts that focus on addressing food insecurity within the healthcare context.