Healthcare Leaders Air Concerns about NQF SDS Trial Period

March 20, 2017 - A group of healthcare organizations wrote a letter to the National Quality Forum (NQF) calling for a one-year extension of the Sociodemographic (SDS) Trial Period that evaluates how social factors impact a hospital's or provider’s ability to influence patient outcomes and healthcare costs.

The American Hospital Association (AHA), Association of American Medical Colleges (AAMC), America’s Essential Hospitals (AEH), and the Federation of American Hospitals (FAH) found that the SDS Trial Period is insufficient for realizing significant takeaways.

By learning about the social factors that affect various parts of the care continuum, the quartet claim that an improved SDS can provide qualitative measures and insights on social factors that affect healthcare. The SDS is conducted by various stakeholders and member groups who contribute data and other models to the greater trial period.

These organizations stated that the length of time did not align with the NQF’s goal of establishing measures that address out-of-practice factors of care.

“Further, the extended trial period would enable measure developers to examine whether there is conceptual evidence demonstrating this linkage and to test specific risk models with robust data sets to identify the potential impact on performance scores,” they wrote. “The goal was to ensure that NQF endorsed accountability measures would represent accurately the quality of care provided, while also shedding light on factors (e.g., within a community) that would be considered outside of a provider’s control.”

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The group of organizations determined that there was a lack of clear oversight and consultation because the NQF used two committees that divided responsibility for unadjusted patient factors. They also said the program is limited in its patient criteria.

“The current NQF measure evaluation criterion on risk adjustment only allows for adjustment of patient factors; yet, as the trial progressed, it became clear that SDS factors should be considered more broadly, such as at the community level, to provide additional perspectives and insights,” they argued.

Another major point of criticism involved the roll-out of  SDS. The quarter deemed the implementation to be “flawed” as a result of a lack of time to truly measure their analyses. Maintenance reviews for SDS measures were promptly moved to other projects.

“Given the evidence provided in the conceptual models that SDS factors influence patient readmissions, it leads us to believe that insufficient data used in the empirical tests of those conceptual models may have contributed to the null results,” the organizations contended.

The letter cited various inaccuracies and incomplete communications between member organizations (who were assisting the NQF’s efforts) and stakeholders of the trial period.

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The last public available data on the SDS hadn’t been updated since October, 2015 without a centralized location available. The organizations emphasized that having accurate, updated information to is critical so stakeholders can use the data to solve socioeconomic complications in healthcare environments.

“The division of responsibility across the CSAC, Disparities Standing Committee and various CDP Standing Committees also made it extremely difficult to follow all of the discussions and evaluations of individual measures and the trial period as a whole, therefore making it difficult to monitor the committee evaluations of measures for appropriate SDS adjustment,” they stated.

These quartet concluded its letter with a set of recommendations to improve future SDS trials and data capture.

The first of which is simply to improve organization of member responsibility, which includes member-by-member goal setting as well as standardized reviews for the NQF to measure progress.

Another recommendation is determining if the measurement criteria within the SDS needs further modification, with the organizations contesting that research materials should clearly define what is intended by conceptual and empirical analyses. The research materials should also outline exactly what factors and data must be provided with the goal of reducing variability in information across submissions.

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“The measure evaluation criteria also should be reviewed to determine whether it is overly prescriptive (e.g., limiting analyses to only patient-level factors),” they said. “This step is particularly important given that this field continues to evolve and the criteria should not limit innovation and improvements to how a measure is specified and represented.”

Through proper collaboration, the organizations claim they can help and support the NQF with overarching goals of using measured results to improve healthcare processes.

“We remain committed to working with NQF to improve its processes and advance health and health care quality through measurement,” they concluded. “Thank you for your consideration of these important issues and our request to extend the SDS trial period for at least one year.”