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Federal Register / Vol. 86, No. 164 / Friday, August 27, 2021 / Notices
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feedback loop by Identifying a set of strategies that can be plloted to Improve the ways In which NQF
solicits, collects, facilitates, and shares measure feedback among stakeholders within NO.Fs endorsement and maintenance processes.
In June 2020, NQF dellvered the final report for the project that focused on a proposal Implementation plan to pilot and evaluate strategies to fmprove the measure feedback loop that allgn with the Committees goals for the measure feedback loop pilot to minimize burden for those providing feedback; ensure relevant stakeholders know how to provide measure feedback to NQF; ensure NO.F
Standing Committees receive meaningful and adequate information to apply the feedback to the relevant measure evaluation criteria and make informed recommendations for endorsement; ensure developers receive timely, meaningful, and actionable measure feedback; ensure those who provide feedback hear back about how feedback was or was not addressed; and define a standard pathway for generating and collecting measure feedback.
The proposed plan for the measure feedback loop pilot implementation consists of three steps: 1
generate meaningful and actionable feedback from measure users; 2 standardize and streamllne the NQF Measure Feedback Tool and measure feedback process; and 3 support stakeholders to apply the measure feedback collected through prior steps. These steps include strategies and tactics that the Committee rated as having high-potential benefit while being at lowto medium-resource Intensity to support the feasibility of Implementing successful strategies beyond the pilot. Continuous efforts to improve the measure feedback loop is vital to the success of the quality improvement enterprise and requires the buy-In and participation of key stakeholders from the healthcare community, Including measure users, measure developers, and NQF Standing Committee members.

Patient-Reported Outcomes: Best Practices on Selection and Data Collection Prior work by NQF created structured recommendations around patient-reported outcomes PROs, patient-reported outcome measures PROMs, and patient reported outcome performance measures PRO-PMs National Quality Forum, 2012b. While the differences between these are subtle e.g., in the context of knee replacement, post-surgical symptoms, such as pain, are considered PROs, a patient-reported survey of the knee Injury and osteoarthritis outcome Is considered a PROM, and the provider performance managing the post-surgical knee pain Is an example of a PROPM. Unfortunately, both the widespread use and adoption of PROs and PROMS have faced barriers, as have the development, endorsement,.and Implementation of PRO-PMS Philpot et al., 2018. Currently, NQFs measure endorsement portfolio Includes seven PROPM measures. These barriers may stem from clinician and patient concerns about upstream factors of PRO-PM development, namely the value and choices of PROs and the selection and implementation of PROMs. Limited relevance of some PROs to patient goals, clinicians concerns about the limited value. of some PROs to care planning, a lack of guidance for cllnlclans on how to Interpret PRO data, and burden of PROM Implementation and incompatibility with workflow have all inhibited efforts to develop and expand the use of PRO-PMs in Informing quality Improvement. To Increase broad-based acceptance of PROPMs, It would be Important to addressthese upstream hurdles related to PROs and PROMs. An environmental scan was published In December 2019, providing a current assessment of PRO use Within healthcare.

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The flnal technlcal report. released In September 2020, built on the environmental scan by providing guidance from the TEP that clinicians and organizations can use in addressing barriers that affect.the selection and implementation of PROs and PROMs . The final report reviews commonly used