From the Science and Quality Council

By: Matthew E. Nielsen, MD, MS, FACS, Chair, AUA Quality Improvement & Patient Safety Committee | Posted on: 01 Feb 2021

As part of the ongoing efforts to assist our members and improve the quality of care they provide to their patients, the AUA has renewed its focus on quality measurement to ensure that AUA Quality Registry (AQUA) measures are clinically sound, reliable, valid and effective.

During the past year, we commenced this effort by conducting a formal evaluation of the urology-specific clinical quality measures included in the AQUA Registry. We convened a 9-person Measure Evaluation Panel (MEP) to help prioritize the measures, assess the precision of the measure specifications and their alignment with the clinical evidence and propose changes to the specifications if needed. We then invited more than 30 AUA members to participate in a modified Delphi process to evaluate the importance, performance, feasibility and face validity of 7 of the measures. The results of this work informed the AUA’s ongoing measure maintenance efforts as well as our selection of measures that will be included in the 2021 Qualified Clinical Data Regstries, which can be used to satisfy the Centers for Medicare & Medicaid Services’ (CMS) Measure-based Incentive Payment System (MIPS) reporting requirements.

Moving forward, the AUA, with input from its Quality Improvement Patient Safety Committee, the MEP and other members, will continue to evaluate the utility of current measures and update and clarify specifications as needed. We will also begin the important process of testing the measures empirically for feasibility, reliability and validity. We also plan to develop a conceptual measurement framework for urological conditions. This framework will serve as a blueprint for the future development of new measures. When developing this framework, we will consider including the many ways new and existing measures may be used (eg for quality improvement, public reporting, value-based payment etc), what topic areas should be prioritized (eg appropriate use, shared decision making etc), what type of measures are needed (eg clinical outcome measures, patient reported outcome and experience measures, process measures closely linked to desired patient outcomes etc) and what data would be required to implement such new measures (eg survey instruments, social risk data for use in risk adjustment etc). Once this framework is in place the AUA will begin a multiyear effort to develop new urology-specific measures.

The AUA is confident that these measurement activities will enhance members’ benchmarking and quality improvement activities. In turn, these will foster more sustainable and engaged participation in CMS quality programs such as MIPS and strengthen the value and utility of the AQUA registry. Ultimately, these efforts will help improve the quality of urological care we provide to our patients, as well as their health more broadly.

Acknowledgment: We thank Karen Johnson, PhD, AUA Director of Quality and Measurement, for her contributions to this article.

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