ACC/AHA/AACVPR/AAFP/ANA Concepts for Clinician–Patient Shared Accountability in Performance Measures

Abstract

ACC/AHA Task Force on Performance Measures Paul A. Heidenreich, MD, MS, FACC, FAHA, Chair Nancy M. Albert, PhD, CCNS, CCRN, FAHA Paul S. Chan, MD, MSc, FACC Lesley H. Curtis, PhD T. Bruce Ferguson, Jr, MD, FACC Gregg C. Fonarow, MD, FACC, FAHA P. Michael Ho, MD, PhD, FACC, FAHA Corrine Jurgens, PhD, RN, ANP-BC, FAHA Sean O'Brien, PhD Andrea M. Russo, MD, FACC Randal J. Thomas, MD, MS, FAACVPR, FACC, FAHA Henry H. Ting, MD, MBA, FACC, FAHA Paul D. Varosy, MD, FACC Table of Contents Preface2134 Structure and Membership of the Writing Committee2134 Disclosure of Relationships With Industry2134 The Need for Shared Accountability2135 Shared Accountability and PMs2136 General Overview2136 Examples of Shared-Accountability Measures2136 Longitudinal Process Adherence2136 Intermediate Patient Outcome Metrics--Reaching Target Goals (Blood Pressure, Hemoglobin A1c)2137 Example of Shared Accountability for Clinical Events and Patient Outcomes2137 Methodological Challenges2138 Accountability and Attribution2138 Potential Levels of Aggregation2138 Defining Patient Attribution2138 Defining Parties Responsible for a PM2138 Defining Assessment Periods for PMs2139 Issues Relating to Patient Adherence and Self-Care2139 Defining Adherence and Self-Care2139 Challenges With Handling Patient Treatment Refusals2139 Adjusting for Patient Case Mix2140 Psychosocial Factors Impacting Patient Case Mix2140 Factors Impeding or Facilitating the Adoption of Shared-Accountability PMs2140 Health Information Systems2140 Payment Reforms, Healthcare Ownership, and ACOs2140 Special Issues Relating to Patient Accountability Metrics2140 Patient PM and Accountability2140 Patient Financial Incentives and Unintended Consequences2141 Conclusion and Key Recommendations2141 References2143 Appendix 1 Author Relationships With Industry and Other Entities (Relevant)2144 Appendix 2 Reviewer Relationships With Industry and Other Entities (Relevant)2145 Preface Structure and Membership of the Writing Committee Members of the Writing Committee included experienced clinicians and specialists in cardiology, cardiac rehabilitation, quality improvement, outcomes research, epidemiology, and performance measures (PMs) methodology, as well as patient advocates. Because the Writing Committee is defining general principles, rather than making specific PM recommendations, members' relationships with pharmaceutical and device companies were not considered relevant to the topic.