Quality Improvement

Committee Process for Public Comment or Voting Process - ACCP Expertise Requested Selection Criteria

Not all of the performance measures sets that are sent to the ACCP for review and comment or approval will be applicable to the membership of the ACCP, and the workload of the Quality Improvement Committee (QIC) would be large if it reviewed them all. Therefore, the following criteria have been developed to select which sets will be brought to the members of the QIC for review and which will not. For those that are not selected, the staff liaison will send a response to the developing or endorsing organization, thanking them for the opportunity, but respectfully declining, based on the fact that there are other organizations whose expertise would be more valuable to that particular review process.

Selection Criteria:

Pulmonary focus Asthma COPD ARDS Pneumonia Lung cancer Bronchitis NAEB Bronchiectasis Tuberculosis Cystic fibrosis Atelectasis Pulmonary abscess Occupational/Environmental lung disease Interstitial lung disease UACS Pulmonary rehabilitation Pulmonary vascular Pulmonary transplant Critical care focus Antithrombotics/VTE Respiratory physiology and monitoring Respiratory therapy issues Arterial blood gas analysis Airway management Endotracheal intubation Tracheostomy Mechanical ventilation Principles of positive pressure ventilation Noninvasive positive pressure ventilation Weaning from mechanical ventilation Respiratory failure Hypercapnic respiratory failure Hypoxemic respiratory failure ARDS Life-threatening asthma Pneumonia Community-acquired pneumonia Nosocomial pneumonia Cardiovascular physiology and monitoring Hemodynamic monitoring principles Shock Cardiac arrest Advanced life support Myocardial infarction and acute coronary syndromes Cardiac arrhythmias Congestive heart failure Hypertensive crisis Renal failure Renal replacement in the ICU Fluid and electrolyte disorders Electrolyte disturbances Crystalloid and colloid administration in the ICU Endocrine disorders in the ICU Adrenal insufficiency Diabetes mellitus and glycemic control Nutrition in the ICU Enteral nutrition Parenteral nutrition GI disorders in the ICU Upper GI bleeding Lower GI bleeding Pancreatitis Hepatic failure Cirrhosis and related complications Hematologic disorders in the ICU Blood product administration in the ICU Bleeding disorders and coagulopathies Oncologic disorders in the ICU Complications of stem cell transplantation Collagen vascular issues in the ICU Nervous system disorders in the ICU Coma and altered mental status Cerebrovascular accident Delirium in the ICU Status epilepticus Neuromuscular disorders Managing sedation, analgesia, and neuromuscular blockade Infectious disease issues in the ICU Infection control/prevention of nosocomial infection Management of immunocompromised patients Antimicrobial agents Fever in the ICU/disorders of temperature control Severe sepsis and septic shock Poisoning and drug overdose Postoperative ICU issues Trauma Head trauma Burns Obstetrical and gynecologic issues in the ICU Allergic and immunologic disorders in the ICU Multiple organ failure Critical care ethics End-of-life issues ICU management Interdisciplinary care ICU family care Performance improvement and patient safety Severity of illness Psychosocial issues in the ICU Pharmacology in the ICU Disaster management Invasive procedures in the ICU Central venous catheterization Arterial catheterization Pulmonary artery catheterization Sleep medicine focus Insomnia Hypersomnia not related to SRBD Parasomnias Sleep-related movement disorders Restless legs syndrome Circadian rhythm disorders Sleep disorders particular to pediatrics Normal sleep physiology OSA, adult—pathophysiology and diagnosis Cardiovascular perspectives of OSA Surgical treatment of OSA Positive airway pressure treatment of OSA Dental appliance treatment of OSA Weight loss and medical treatments for OSA OSA, pediatric Central sleep apnea syndromes Cardiovascular perspectives of central sleep apnea Sleep-related hypoventilation/hypoxemic syndromes Nocturnal noninvasive ventilation OSA and metabolic disorders Polysomnography Portable monitoring MSLT/MWT Actigraphy Sleep-related problems in medical disorders Sleep-related problems in neurologic disorders Sleep-related problems in psychiatric disorders Sleep in the ICU Sleep deprivation Sleep in women Sleep and aging Legal issues in sleep medicine Other Tobacco cessation Criteria for Assessment of Performance Measures

The Quality Improvement Committee (QIC) developed a set of criteria to use in the review of proposed performance measures for improvement purposes and possible ACCP endorsement. These criteria will not only define the scope of the group’s determinations but also the specific standards by which the performance measures should be evaluated.

QIC objectives:

Reliable and valid criteria Measurability Clinical applicability Ease of implementation, including education on implementation

Criteria for Assessment of Performance Measures:

Practicality for ACCP members and their patients Helpful to ACCP members, including physicians, nurses, and other practitioners Appropriate to the diversity of physicians and type of hospitals of ACCP members, including variation in practice size and location Ease of data collection for ACCP members Any other barriers that are specific to ACCP chest, critical care, and sleep medicine physicians Importance Assesses an important leverage point for improving quality: significant to target audiences; impact on health Opportunity for improvement, considerable variation in quality of care exists Aspect of quality is under provider or health system control This measure does not create incentives or rewards to improve without truly improving quality of care Scientific acceptability Relationship to quality is based on best available scientific evidence Well defined and precisely specified Valid and measures the intended aspect of quality; accurately represents the concept being evaluated; data sources are comparable Adequate proportion of total variation is explained by provider performance and amount of variation in measurement is small after provider performance and patient characteristics are taken into account Reliable, producing the same results a high proportion of time in the same population Precise, adequately discriminating between real differences in provider performance and reasonable sample size exists to detect actual differences; captures all possible cases and bias related to case exclusion or limited data are minimal Risk adjustment is adequate to address confounding bias, if applicable Usability Effective (understandable and clear) presentation and dissemination strategies exist Statistical testing can be applied to communicate when differences in performance levels are greater than would be expected by chance Has been used effectively in the past and/or have high potential for working well with other indicators currently in use Compelling content for stakeholder decision making Feasibility Consistent construction and assessment of the measure Feasible to calculate; benefits exceed financial and administrative burden of implementation Confidentiality concerns are addressed Audit strategy can be implemented, quality of data is known

Overall, is this performance measure acceptable as written?

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