Metrics & Scoring Committee June 15, 2018 HEALTH POLICY & ANALYTICS Office of Health Analytics
Today’s Agenda Welcome – Review and approve May minutes – HPQMC debrief – Measure development updates (and guidance from Committee) – CCO 2.0 standing update Presentation on statewide areas for quality improvement 2019 measure set selection – Review TAG and Committee homework – OHA staff recommendations and information for consideration – Begin selecting 2019 measure set! Please note this meeting is being recorded. The recording will be made available on the Committee’s webpage: http://www.oregon.gov/OHA/HPA/ANALYTICS/Pages/Metrics- Scoring-Committee.aspx 2
Review May Minutes 3
Committee Appointments • Four Committee members termed out/chose not to reapply • OHA is reviewing applications (including from those reapplying) • New Committee members will be invited to attend July meeting (as non-voting members) • New appointments begin in August 4
HPQMC Updates 5
Measure set finalized for 2019. Available online and in packet: https://www.oregon.gov/oha/HPA/ANALYTICS/Quality%20Metrics%20Committ ee%20Docs/2019-Aligned-Measures-Menu.pdf • Measure Categories – Menu: measures from which payers can choose – On Deck: measures that are not yet ready to be implemented, but have near-term potential – Developmental: measure concepts that address important areas of health/ outcomes but for which ( generally) a specific measure has not been defined and/or not yet validated and/or tested 6
Menu Set Highlights 51 health care quality measures 6 domains of health care services (and 5 sub domains) Each measure has a measure steward Each measure is matched to at least one health care sector 7
Measure Categories: MENU, On Deck, Developmental 8
Measure Categories: Menu, On Deck, DEVELOPMENTAL Developmental: Measure concepts that address important areas of health/ outcomes but for which a specific measure has not been defined and/or not yet validated and/or tested Twenty developmental measures with eight selected as highest priority. – Evidence-based obesity measurement (in progress) – Health Aspects of Kindergarten Readiness (in progress) – Developmental screening in the first 36 months of life and follow-up – Suicide Risk Assessment – Children and youth with special health care needs survey (based on questions from FECC, PICS, and CAHPS) – Unexpected complications in term newborns – Food insecurity screening – Screening measure for Hep C and HIV (two measures, but potentially similar or parallel development process) 9
June 14 meeting updates… The HPQMC meets the 2 nd Thursday of each month. Meeting agendas, • minutes, materials, and recordings can be found on the committee website: http://www.oregon.gov/oha/HPA/ANALYTICS/Pages/Quality-Metrics- Committee.aspx
Measure Development Work 11
Obesity Metric Workgroup • Met for the first time on May 31st – Reviewed evidence on effective obesity interventions – Brainstormed potential components of an evidence- based obesity measure – Agreed that the measure developed: Move beyond just clinical interventions / components, and is looking toward development of a multiple component, cross-sector measure Look at linkages with SDOH Is not duplicative of other metrics Feasibility is critical • Next meet June 25 th . 12
Health Aspects of Kindergarten Readiness • Fourth meeting was June 7th; meet again June 29th • June 7th meeting was first time using conceptual framework to assess measures that are already in existence • Considering options for composite / phased measures 13
CCO Incentive Measures: Health Health Aspects of Kindergarten Readiness Aspects of Kindergarten Readiness *Created by OPIP for HAKR Technical Work Group 5/25/18 meeting led by Children’s Institute and supported by OHA 14
Standing CCO 2.0 Update Stephanie Jarem, OHA 15
Public testimony HEALTH POLICY & ANALYTICS Office of Health Analytics 16
Oregon’s health priorities: Recommendations to the Metrics and Scoring Committee on areas of unmet need Katrina Hedberg, MD, MPH Health Officer and State Epidemiologist Lisa Bui, MBA Quality Improvement Director June 22, 2018 OFFICE OF THE STATE PUBLIC HEALTH DIRECTOR Public Health Division
Purpose for today’s discussion • Provide update on progress toward meeting state health improvement plan and other health priorities in Oregon. • Highlight gaps in statewide performance and opportunities for improvement through CCO metrics 18
State Health Improvement Plan (SHIP) Priorities, 2015-2019 • Reduce tobacco use • Slow the increase of obesity • Reduce the harms associated with alcohol and substance use • Improve oral health • Prevent deaths from suicide • Improve immunization rates • Protect the population from communicable disease • Also, maternal and child health 19
Currently in M&S Measurement Set Prevent and reduce Prevent and reduce tobacco use obesity* Decrease: Decrease • • Cigarette smoking Obesity among 2- to 5-year- prevalence among youth olds • • Other tobacco product (non- Obesity among youth cigarette) use among youth • Obesity among adults • Cigarette smoking • Diabetes among adults prevalence among adults *glide path workgroup started for a evidence based metric 20
Currently in M&S Measurement Set Improve Immunization Maternal and Child rates Health Increase: Existing CCO measures for improving maternal and child • Rate of 2-year-olds who are health fully vaccinated • Effective contraceptive use • HPV vaccination series rate among women at risk of among 13- to 17-year-olds unintended pregnancy • Seasonal flu vaccination • Timeliness of prenatal care; rates in people ≥6 months of consider adding postpartum age measure component • Developmental screening in the first 36 months of life (Enter) DEPARTMENT (ALL CAPS) (Enter) Division or Office (Mixed Case) 21
Improve oral health Priority targets Decrease • Third graders with cavities in their permanent teeth • Adolescents who have ever had a cavity • Prevalence of older adults who have lost all their natural teeth 22
Key strategies for improving oral health Population interventions 1. Increase the number of fluoridated public water districts Health system interventions 1. Adopt incentives for improving oral health 1. CCO incentive metric: Dental sealants on permanent molars for children 2. Increase early preventive care for children 3. Include oral health in chronic disease prevention and management 23
Children with dental visit in the past year, by age group 100% 93% 93% 90% 80% 80% Percent of children 60% 54% 40% 20% Total 0% 0 – 5 6 – 9 10 – 13 14 – 17 Total Age group in years Source: 2016 National Survey of Children's Health 24
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Prevent deaths from suicide Priority targets Decrease • Rate of suicide • Suicide attempts among 8th graders • Emergency department visits for suicide attempts 27
Key strategies for suicide prevention Population interventions 1. Promote use of the National Suicide Prevention Lifeline 2. Ensure communities implement services and programs to promote safe and nurturing environments Health system interventions 1. Adopt incentive measures for suicide prevention a) CCO incentive measure: Depression screening and follow up plan b) State performance measure: Follow-up after hospitalization for mental illness 2. Establish universal screening for individuals at risk of suicide 28
Suicide deaths by year, Oregon and US 20 17.8 Oregon Rate per 100,000 residents 16 14.1 13.3 (age-adjusted) U.S 12 10.4 8 4 0 Source: CDC's WISQARS 29
Suicide deaths by age and sex, Oregon 42.7 45 38.8 40 Rate per 100,000 residents 32.9 35 28.5 30 25 20 13.9 15 8.8 Female 7.8 7.3 10 5.6 4.3 Male 5 0 10 to 17 18 to 24 25 to 44 45 to 64 65+ Age in years Source: CDC's WISQARS 30
Protect the population from communicable diseases Priority targets Decrease: • Gonorrhea in women aged 15 – 44 years • HIV infections in Oregon residents • Hospital-onset Clostridium difficile infections • Infections caused by the Shiga toxin-producing Escherichia coli infections in children under 10 years 31
Key strategies for communicable disease control Population interventions 1. Reduce non-judicious antibiotic prescriptions Health system interventions 1. Adopt incentives for communicable disease control a) State performance measure: Percent of two year-olds who received recommended vaccines b) HPQMC developmental measure areas for HIV and hepatitis C screening 2. Promote use of expedited partner therapy by health care providers 32
HIV diagnoses and deaths, Oregon
Racial disparities in HCV outcomes, Oregon, 2009-2013 150 127.7 124.4 100 Chronic HCV 57.5 50 0 10 Liver Cancer 5.1 4.1 3.1 0 20 17.4 16.1 8.9 Deaths 0 AI/AN Black White
Reduce harms associated with alcohol and substance abuse Priority targets Decrease • Prescription opioid mortality • Alcohol-related motor vehicle deaths 35
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