Meeting Notes
Present: John Alfano, Joan Armbruster, Joyce Bachman, Penny Baughman, John Bianconi, Cathy Chadwell, Sonia Chambers, Vicki Douglas, Mary Emmett, Laura Friend, John Grey, D. Parker Haddix, Janie Hardman, Cindy Haynes, Sallie Hunt, Sandra Joseph, Dave Lambert, Thomas Lanava, Elizabeth LaPlante, Kenna Levendosky, Fred Lewis, Sam Kapourales, Tamara King, Martha Morris, Pam Neal, Cindy Neely, Paul Nusbaum, Roland Parsley, Bob Plymale, Joan Propst, Carol Ragan, Annette Riehle, Laura Rhodes, Debbie Ruppert, Linda Sovine, Scott Spradling, Paula Staud, Cathy Taylor, Henry Taylor, Cindy Tennant, Donald Weston.
Welcome and Introduction
D. Parker Haddix, Chairman of the West Virginia Health Care Authority and Quality Utilization Advisory Group (QUAG), called the meeting to order at 10:10 a.m. Mr. Haddix provided an overview of the development of the Quality Utilization Advisory Group resulting from Senate Bill 458. He further described the creation of three sub-teams to address the following areas: necessity of admissions, length of stay, and quality of care. The Quality of Care Sub-Team identified four targeted population-based disease/injury areas to include: Diabetes, Cardiovascular Disease, Low Back Injury, and End-of-Life Care. Mr. Haddix summarized the multi-phase program development and implementation plan completed by the QUAG in July 1999. The plan phases are: research related programs and initiatives in other states; design data collection and analysis systems; collect and analyze data for West Virginia; develop benchmarks measurement systems and improvement initiatives; and develop a system of sanctions and incentives in support of quality improvement and reporting initiatives.
Finally, he noted that the Quality of Care Sub-Team will sequentially address each targeted area through the creation of expert panels and identification of quality indicators, the first slate being presented today for End-of-Life Care. Audience members were encouraged to access the HCA Web site for additional information at: www.hca.wv.gov/policyandplanning/quality/Pages/default.aspx.
Review of Proposed End-of Life Care Quality Indicators
Dr. Mary Emmett, Director, Researcher for the West Virginia Health Care Authority, provided an introduction to the proposed indicators (see Attachment 1) by providing a summary of the work of the expert panel. She noted that data sources were indicated for each indicator. In addition, the MDS and OASIS questions relating to pain management were included for those not familiar with these databases. It was also noted that no national data source currently exists for obtaining hospital performance data related to pain management. She opened the floor for questions on the process and handout listing the proposed indicators. John Alfano inquired about the availability of national statistics for location at time of death and Dr. Emmett stated these could be provided. The group then divided into 3 work groups to review and discuss the proposed indicators in detail.
Following individual group discussion, a spokesperson for each group summarized their recommendations (see Attachment 2). After the presentations and a break for lunch, Dr. Emmett called for the group's overall recommendations on the set of proposed End-of-Life Care Indicators.
Recommendation
Acceptance of the proposed slate of indicators for End-of-Life Care
Review and Presentation of a Proposed Definition of Quality
The State Health Plan includes quality policy initiatives. One of those is to develop a definition of quality that would guide the work of the QUAG. The West Virginia Medical Institute (WVMI) and the WVHCA are the lead agencies responsible for the implementation of the SHP quality policies and were asked to provide the QUAG with an opportunity to develop a definition. On behalf of Dr. John Brehm, WVMI, Dr. Mary Emmett continued the meeting with a presentation and discussion of definitions for quality, developed previously through work at the Institute of Medicine (IOM). These definitions are consistent with the intent of Senate Bill 458, to assist the group. She advised that the group was free to choose or alter an existing definition, or develop one of their own. It was suggested that the group accept the definition used in the IOM report, Crossing the Quality Chasm, 2001 with the additional mention of the aims also listed in that report. Following some discussion of the meaning of "technically competent" and "cultural sensitivity" it was decided to accept the definition as currently worded. It was also noted that cost and reimbursement issues are integral factors in determining quality of care and should be recognized. Dr. Emmett stated that the aim of "efficiency" addressed some concerns but that this issue bears ongoing consideration.
Recommendation
Accept the definition and Aims from the IOM report Crossing the Quality Chasm, 2001: "Good quality means providing patients with appropriate services in a technically competent manner, with good communication, shared decision making and cultural sensitivity." Crossing the Quality Chasm Aims: Safe, Effective, Patient-centered, Timely, Efficient, Equitable (see Attachment3).
Work Plan Review
Dr. Mary Emmett concluded the formal agenda with a presentation of a projected work plan for Quality Indicator development. She noted that the major activities related to the Cardiovascular indicators set will begin around December 2001 while initial work for the Diabetes measures will begin in early fall 2001. Low Back Injury Indicator development is underway and will proceed with literature review, and convening the expert panel in August 2001, with a target of having indicators identified by December 2001 or January 2002. This work plan will serve as a blueprint for indicator development subject to the influence of external or unanticipated factors.
Closing discussion by group members identified some opportunities to combine efforts with other state level activities. Cathy Taylor described the West Virginia Health Initiative Pilot project involving Diabetic Care for Medicaid recipients. She noted that this project will be extended to a statewide initiative in July 2001. This project works to improve diabetic care through education using certified nurse educators and enhanced care protocols initiated by participating physicians. Data will be collected and may be useful for the indicator project. Cathy volunteered to facilitate any collaborative activity with the Medicaid office, Public Health and the Quality of Care Group.
Representative Vicki Douglas advised the group that a legislative committee is convening to look at medical errors. She encouraged anyone having relevant data that they could share, to contact her directly. Finally, Paul Nusbaum, Secretary WVDHHR, noted the unique opportunity this group has to influence the health of West Virginians and encouraged the group to share findings and recommendations with the legislature in upcoming sessions.
Dr. Emmett thanked the group for their enthusiastic participation in the day's activities and resulting recommendations. Minutes will be sent to all members in follow-up to today's meeting and posted on the HCA Web site.