NQF Proposes Quality Framework for Rural Telehealth
Quality measurement has not kept up with the expansion in telehealth usage models during the COVID-19 pandemic. A National Quality Forum (NQF) multistakeholder committee has issued a report with guidance on how to assess the impact that telehealth has on healthcare system readiness and health outcomes during emergencies such as pandemics and natural disasters, specifically for rural areas.
The NQF project, funded by the Centers for Medicare & Medicaid Services (CMS), conducted an environmental scan of peer-reviewed literature on how telehealth is being used in rural areas to deliver care during or for emergencies, the evolving telehealth policy and practice landscape, and quality measures related to telehealth and healthcare system readiness.
“The pandemic has changed forever how we deliver care in times of disaster. Our work will provide guidance as to how that care is best delivered,” said Committee Co-Chair Dr. William Melms, M.D., chief medical officer at Marshfield Clinic Health System, in a statement.
Building on the environmental scan and the 2017 Telehealth Measurement Framework, the committee’s report puts forward a conceptual measurement framework to guide quality and performance improvement for care delivered via telehealth in rural areas in response to disasters.
The framework includes five domains:
• Access to Care and Technology: the ability of telehealth to increase rural patients’ access to certain types of healthcare during emergencies
• Costs, Business Models, and Logistics: the costs of using telehealth, how it is supported financially, and delivery model implications
• Experience: how interactions of patients/caregivers and care team members through telehealth meet their needs and preferences
• Effectiveness: the desired outcomes, safety, and timeliness of care delivered via telehealth
• Equity: how telehealth can help support equal opportunities for all people to be healthy
Considerations for each domain are outlined along with rural-specific measurement issues and potential solutions (e.g., low-patient volumes, broadband access, role of local organizations in influencing health, and local resources).
In using the framework, the committee examined and selected 26 performance measures aligned with the five domains that should be prioritized for use to assess care delivered via telehealth in rural areas affected during emergencies and disasters. These measures focus on access to care and specialists, acute care needs, admissions and readmissions, behavioral health, care coordination, and patient experience.
Measure gaps exist in the priority areas identified in the framework. Several prioritized measure concepts are proposed that aim to fill these gaps. Specifically, measures are needed that address the digital divide, timeliness of care, telehealth care utilization during emergencies, adaptability and healthcare system readiness, health equity (e.g., focused on social determinants of health [SDOH], health literacy, and health disparities), and experience with telehealth.
Ten recommendations summarize current priorities for evaluating rural telehealth during emergencies and underscore key areas for future measurement. This report is intended to help stakeholders identify which measures are available for use, encourage the development of new measures that address gaps, and promote the use of such measures to assess the impact of telehealth on healthcare system readiness and health outcomes in rural areas affected by large-scale emergency events.
