A National Quality Forum committee has created a framework for telehealth quality measurement and identified 16 existing NQF-endorsed measures that can be used initially to measure the impact and quality of telehealth.
In a newly released report, NQF recommends measuring the quality of telehealth in four broad categories: patients’ access to care, financial impact to patients and their care team, patient and clinician experience, and effectiveness of clinical and operational systems. Within these categories, NQF identified six key areas as having the highest priority for measurement in telehealth, including: travel, timeliness of care, actionable information, added value of telehealth to provide evidence-based practices, patient empowerment, and care coordination.
During a Sept. 5 webinar presentation about the report, Judd Hollander, M.D., associate dean for strategic health initiatives at Thomas Jefferson University in Philadelphia and co-chair of NQF’s Telehealth Committee, said the NQF quality measure framework is designed to inform policy across the spectrum of payment models as telehealth becomes more ubiquitous. “People are going to get medical care, and one of the ways we’ll deliver it is telemedicine. But we have to know how to measure and report on quality and figure out how we can inform reimbursement in an evidence-based manner.”
Marcia Ward, Ph.D., director of the Rural Telehealth Research Center at the University of Iowa and co-chair of the committee, said there are many existing measures that capture quality. “We could have just gone to those and pulled ones we thought were a good fit for telehealth,” she said, “and to some extent we did, but besides being similar to face-to-face care, telehealth does have particular attributes that lend to a subset of measures that capture the uniqueness of telehealth.”
The committee identified concepts that will play a key role as quality measures are developed. One example is travel, which is important in rural telehealth. Ward noted that the telestroke program at the Medical University of South Carolina tracks how many patients at rural hospitals are able to stay in their local community rather than traveling long distances to the academic medical center. Another measure is timeliness of care, she added. In rural communities, the ability to connect local providers with specialists and deliver time-critical care can be enhanced with telehealth, so it is an important measure concept.
The committee said the report and the conceptual framework it developed could serve as the foundation for future efforts by measure developers, researchers, analysts and others to advance quality measurement for telehealth. By identifying some of the highest-priority areas for measurement, this report may support the development of measures that incorporate into a telehealth environment as part of an iterative development process. Measurement based on iterative and continuous learning will successfully inform future telehealth quality improvement efforts, including emerging areas such as patient empowerment and care coordination, the NQF report noted.
Below is one case study from the report, followed by a description of the domains, subdomains and measure concepts that might apply:
Managing Mild to Moderate Heart Failure Symptoms
Frances is a 63-year-old retired teacher with mild to moderate heart failure. She notices one morning that she is a little more winded than usual and texts her doctor’s office. The office responds with a text link to 10 different time slots for a video visit later that day. She selects one and later that day has a 10-minute video chat with her doctor, who suggests some alterations to her medications. She feels reassured and goes to bed, but awakens in the middle of the night with shortness of breath. She gets frightened, and uses a mobile health application on her phone where she connects with an emergency physician within minutes. The emergency physician assesses her respiratory rate and recommends that she take an additional dose of diuretic. The on-demand doctor schedules an early-morning visit by the community paramedicine team who check her blood pressure, heart rate, oxygenation, and weight. She then participates in a five-minute check-in to review her medication plan with her primary care physician (PCP). The team leaves her a Bluetooth-enabled scale that communicates with the office of her PCP, and they discuss a plan for diuresis to achieve a five-pound weight loss over the next few days.
Primary Framework Domains
Experience
Effectiveness
Access
Financial Impact/Cost
Applicable Framework Subdomains
Patient, family, and/or caregiver experience
System effectiveness
Clinical effectiveness
Technical effectiveness
Access for patients, families, and/or caregivers
Financial impact to health plans or payers
Potential Measure Concepts
Patients demonstrated increased understanding of care plan
Technologies were in a satisfying condition for providers to do their job
The instructions for care were clear to the patient
Able to provide care without admission into the ER
