Quality Criteria and Required Clinical Processes



Quality Criteria and Required Clinical Processes

The Alliance developed QualityPath criteria with support and input from clinical experts, professional associations and other leaders in measuring clinical quality.

The QualityPath criteria are comprised of national quality and process measures, including:

  • Performance on outcome measures: Doctors and hospitals must perform at or above the national average on outcome measures such as complication and readmission rates.
  • High-tech diagnostic imaging: Doctors must use software to help decide whether imaging tests are evidence-based, which reduces potential harm to patients through unnecessary imaging.
  • Shared decision-making: Where there is more than one treatment option, doctors and hospitals must offer alternatives and involve patients in making the decision.
  • “Advance directives:” The doctor and other caregivers must have a conversation with the patient about future care needs and, when possible, document them as an “advance directive.”
  • Joint School: For hip and knee replacements, hospitals and doctors must encourage participation in a pre-surgery joint school to prepare patients for surgery and their role in recovery.
  • Patient-reported outcomes: For hip and knee replacements, hospitals and doctors must gather data directly from patients on how the surgery impacts their pain and their function (also known as “functional status”), both before and after surgery.
  • Disclosure of conflicts of interest: The hospital and doctor must disclose any potential conflicts of interest in the form of direct or indirect medical industry payments that are not for medical care.
  • Registry participation: Hospitals and doctors must participate in appropriate professional registries related to QualityPath procedures and make their results public if there is an option to do so. Registry participation leads to better measurement of important outcomes for patients and helps clinicians gain new insights to improve care.

QualityPath designated doctors and hospitals also agree to provide care at a bundled price that covers all elements of the procedure and to offer a warranty to protect patients and employers against the cost of any related complications.