Patient-Reported Outcome-Based Performance Measures in Alternative Payment Models: Current Use, Implementation Barriers, and Principles to Succeed.

OBJECTIVES: Patient-reported outcome (PRO)-based performance measures (PRO-PMs) offer opportunities to aggregate survey data into a reliable and valid assessment of performance at the entity-level (eg, clinician, hospital, and accountable care organization). Our objective was to address the existing literature gap regarding the implementation barriers, current use, and principles for PRO-PMs to succeed. METHODS: As quality measurement experts, we first highlighted key principles of PRO-PMs and how alternative payment models (APMs) may be integral in promoting more widespread use. In May 2023, we reviewed the Centers for Medicare and Medicaid Services (CMS) Measures Inventory Tool for active PRO-PM usage within CMS programs. We finally present principles to prioritize as part PRO-PMs succeeding within APMs. RESULTS: We identified 5 implementation barriers to PRO-PM use: original development of instrument, response rate sufficiency, provider burden, hesitancy regarding fairness, and attribution of desired outcomes. There existed 54 instances of active PRO-PM usage across CMS programs, including 46 unique PRO-PMs within 14 CMS programs. Five principles to prioritize as part of greater PRO-PM development and incorporation within APMs include the following: (1) clinical salience, (2) adequate sample size, (3) meaningful range of performance among measured entities and the ability to detect performance change in a reasonable time frame, (4) equity focus, and (5) appropriate risk adjustment. CONCLUSIONS: Identified barriers and principles to prioritize should be considered during PRO-PM development and implementation phases to link available and novel measures to payment programs while ensuring provider and stakeholder engagement.

Changes in mental health outcomes with the intensive in-home child and adolescent psychiatric service: a multi-informant, latent consensus approach.

This study investigates the Intensive In-home Child and Adolescent Psychiatric Service (IICAPS), a large-scale home-based intervention that collaboratively engages the family, school, and various other service providers (e.g. health practitioners or judicial systems) to prevent the hospitalization, institutionalization or out-of-home placement of children and adolescents with serious emotional disturbance. Multi-informant data (youth, parents and clinician) on the level of youth problem severity and functioning was gathered from 7169 youth and their families served by the IICAPS network, pre- and post-intervention. A newly developed "Multi-informant Latent Consensus" (MILC) approach was employed to measure mental health "baseline levels" and change, within a Structural Equation Modeling framework. The MILC approach demonstrated promise integrating information from multiple informants involved in the therapeutic process to yield a more accurate and systemic view of a child's level of functioning and problem severity than each report taken individually. Results indicated that the IICAPS family and community based intervention model led to a reduction of problem severity and improved functioning in children and adolescents with severe emotional disturbance.

Intensive intervention improves primary care follow-up for uninsured emergency department patients.

OBJECTIVES: To test an intervention designed to improve primary care use and decrease emergency department (ED) utilization for uninsured patients using the ED. METHODS: Using a randomized design, an intensive case-management intervention was tested with patients identified at a Level 1 urban trauma center from April 2002 through July 2002. Following assessment in the ED, six-month follow-up data were gathered from four primary care sites (two Federally Qualified Health Centers, two hospital outpatient clinics) and two area hospitals. Eligible participants were uninsured, were at least 18 years of age, and did not have a regular primary care provider. Of 281 patients approached, 273 (97.2%) agreed to participate. After 42 patients were eliminated following enrollment due to ineligibility, there were 121 intervention and 109 comparison subjects. Health Promotion Advocates (HPAs) in the ED gathered information from all study participants. On intervention shifts, HPAs assisted patients in choosing a primary care provider and faxed all information to a case worker at the selected site. Case managers attempted to contact patients and schedule appointments. On comparison shifts, patients received care as usual. Primary care contact in 60 days and subsequent ED visits in six months post-ED assessment were the main outcome measures. RESULTS: Intervention subjects were more likely to have a primary care contact (51.2% vs. 13.8%, p < 0.0001). There was no statistically significant difference between groups in either number of inpatient admissions or postintervention ED visits, although postintervention ED visits for the intervention group were less expensive. CONCLUSIONS: This project has demonstrated that it is possible to improve primary care follow-up for uninsured ED patients.