A new report details concepts for shared accountability in performance measures between clinicians and patients. The report comes from the American College of Cardiology (ACC), American Heart Association, American Association of Cardiovascular and Pulmonary Rehabilitation, American Academy of Family Physicians and the American Nurses Association in collaboration with other professional organizations.

Published Nov. 3 in the Journal of the American College of Cardiology, the report examines the use of performance measures and how their implementation may be improved for care.

"While performance measures have traditionally been clinician-focused, their goal of improving patient outcomes is heavily dependent on the healthcare system as well as patient actions," ACC executives said. "Recognizing this, the developing organizations sought to outline the key concepts, measurements, and considerations for implementing patient-clinician shared-accountability performance measures."

The report advocates for shared accountability to be considered during the process of developing, analyzing, reporting and interpreting performance measures. Shared-accountability performance measures track patient actions that affect outcomes – such as following treatment plans, taking medications as prescribed, going to follow up appointments, and maintaining lifestyle changes – along with physician processes. The use of shared-accountability performance measures, which recognizes the “inextricably linked” nature of patient and clinician action, has been advocated by the Institute of Medicine.

To implement shared-accountability performance measures, patients must have “sufficient support and knowledge to actively participate in their health care,” the report says. Shared goal setting, shared decision making, and shared care planning and monitoring between patient and clinician are all important concepts to implement as part of shared-accountability performance measures, according to the report.

Further, measures should be shifted from assessing acute care processes to longitudinal outcomes, as measures are best utilized when chronic therapy is evidence-based and supported by guidelines.

The document also examines the need to risk adjust for patient case mix, considering such factors as cultural beliefs, religion, socioeconomic status, and clinical characteristics. Moreover, the report addresses the health information infrastructure necessary for tracking patients across multiple healthcare settings and highlights current payment reform policies that support the adoption of concepts behind shared-accountability performance measures.

Noting that performance should be reported back to both clinicians and patients to facilitate improvement, the report additionally cautions that careful monitoring should be conducted to ensure implementation does not result in a negative clinician-patient relationship, adverse patient selection by clinicians, or greater barriers to care. Instead, focus should be placed on uniting the various stakeholders in a collaborative effort to enhance care quality.

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