Statement on the Management of Performance Measures by the American Society of Anesthesiologists

Developed By: Committee on Performance and Outcomes Measurement
Last Amended: October 18, 2023 (original approval: October 15, 2000)

BACKGROUND AND PURPOSE
The American Society of Anesthesiologists (ASA) recognizes the importance of developing and implementing quality performance measures to collect data on clinical performance and outcomes in today’s health care environment. Benchmarking performance using defined measures or metrics is essential to improving patient care and outcomes. Furthermore, continued public health awareness and emphasis on the delivery of medical care have elevated issues of patient safety,  quality of care and value. Hospitals, insurers, regulatory bodies, and patients increasingly expect physicians to demonstrate their ability to render high-quality and cost-effective health care.  Quality performance measures are the primary means by which to continuously assess clinical performance. 

As the voice of the specialty of anesthesiology, the ASA develops and maintains quality performance measures and feedback mechanisms for physician anesthesiologists to benchmark their outcomes to facilitate quality improvement, reduce disparities, establish healthcare priorities, and track resource utilization. Identification of clinical data that has the potential to improve clinical outcomes is critical to the meaningful improvement of patient outcomes and experience.  Data includes processes of care, clinical and patient-reported outcomes, patient satisfaction, resource utilization, and comorbidity data.  Quality performance measures include both individual and team-based shared accountability measures.  The collection of organizational or structural data permits the identification of relationships between practice characteristics and clinical outcomes.   

Quality performance measures developed by the ASA Committee on Performance and Outcomes Measurement (CPOM) on behalf of the ASA are used by the Anesthesia Quality Institute (AQI) National Anesthesia Clinical Outcomes Registry (NACOR), federal payment programs and other stakeholders with an interest in processes and outcomes in anesthesiology.  

Definitions:

Quality Performance Measures: Quality Performance Measures assess clinical performance, outcomes, and experiences of care.  Quality Performance Measures developed by CPOM follow the Centers for Medicare and Medicaid Services (CMS) measures blueprint or other processes used by consensus-based measure development and endorsement entities for adoption in national reporting programs.  Quality Performance Measures are tested for feasibility, reliability, validity, and usability.  They go through yearly reviews and revisions with concurrent testing of each measure revision.  

Quality Metrics: Quality Metrics describe or highlight specific areas for potential quality improvement purposes by anesthesiologists and anesthesia practices.  Metrics may be developed by expert consensus but have not followed the CMS measures blueprint for development or been tested for feasibility, reliability, validity, and usability.  Quality Metrics once vetted and tested have the potential to be developed into Quality Performance Measures for use in public reporting programs.   

Clinical Indicators: Data elements that an anesthesiologist or anesthesia practice may locally implement to track performance over time on specific patient safety or quality events, never events, or infrequent events that may result in significant patient morbidity or mortality. Should an indicator point to a significant gap in care or a necessary large-scale quality improvement initiative, then a Clinical Indicator could be put forth to become a Quality Performance Measure.