Core measures are a set of care or treatment standards identified by the Centers for Medicare and Medicaid Services (CMS) and/or The Joint Commission (TJC) that have been shown through best scientific evidence to decrease the risk of complications, prevent recurrences, and improve patient clinical outcomes overall. The standards are often time-sensitive and designed for specific conditions.
On a monthly or quarterly basis, each health care facility collects compliance data on these measures and reports the data to the CMS, the TJC, or both. These compliance data sets are used to measure the quality of care provided to patients in a health care setting.
CMS and TJC experts constantly review the most current evidence-based literature and update, amend, or add measures on an ongoing basis at least twice a year. Measures may also be retired when high performance rates are consistently achieved and reported. Retirement means that data no longer need to be reported to the CMS or TJC on the specific measure, but performing the described activity is still important for the delivery of quality care.
Multiple federal and TJC reporting programs require data collection on clinical measures, including the Inpatient Psychiatric Facility Quality Reporting Program, Hospital Outpatient Quality Reporting Program, Inpatient Rehabilitation Facility Quality Reporting Program, and TJC certification programs, including those for stroke, heart failure, and acute myocardial infarction. The core measures addressed in these programs are not covered in this module, which focuses on the Inpatient Quality Reporting Program and the Joint Commission ORYX reporting program.
Measures are revised and published in the “Specifications Manual for National Hospital Inpatient Quality Measures” or in the “Specifications Manual for Joint Commission National Quality Measures.” Please refer to the latest edition of these manuals. Current inpatient measures include the following:
The overall goal of the core measures program is to ensure that the right patient receives the best care in a timely manner every time. The core measures program was designed to remove variation from care processes, increase collaboration across the continuum of care, and enhance the quality of patient care.
Core measures include a wide variety of care activities, many of which are the practitioner's responsibility, such as ordering medications and diagnostic studies. The nurse's role is to initiate, perform, and document interventions, such as laboratory and radiology testing, medication administration, patient education, and discharge planning, in a timely manner.
Compliance with these measures affects CMS reimbursement for care and TJC accreditation. The CMS and TJC regularly release health care facility performance ratings to the public for many of these measures to enable informed consumer decision making.
The CMS and TJC are now requiring some core measures to be electronically abstracted from the patient's electronic health record rather than or in addition to being manually abstracted. These electronic clinical quality measures (eCQMs) originate from the Federal Electronic Health Record Incentive Program and include several measures that had been retired by the CMS and TJC.
The specifications for eCQMs may also differ from the specifications for chart-abstracted measures and are defined in a separate manual. The CMS identifies a minimum number of the available eCQMs that must be submitted each quarter; hospitals are also required to submit these eCQMs for one calendar year. TJC is now requiring hospitals to select a portion and submit data for these selected eCQMs. A complete list of acceptable manual and electronic measures can be obtained from TJC at https://www.jointcommission.org/joint_commission_measures_effective_january_1_2017/
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