This section describes some of the leading performance measurement sets used by one or more government health care programs (see Table 4-1).

Consumer Assessment of Health Plans

CAHPS is a survey instrument and reporting system developed, with funding and direction from the Agency for Healthcare Research Quality (AHRQ), to help consumers and purchasers choose among health care plans. CAHPS employs primarily outcome measures—specifically consumers’ perceptions of their health plan and personal providers—and is used by some state Medicaid agencies, the Medicare program, DOD TRICARE, and public and private employers. NCQA requires managed care plans to field CAHPS and to develop quality improvement projects that address problems identified through CAHPS findings. JCAHO similarly encourages, but does not require, some accredited health care organizations, such as health networks, to employ CAHPS.

CAHPS was originally conceived as a tool for managed care, but more recently has been adapted for fee-for-service (FFS) purposes. There are publicly available algorithms for developing and reporting standardized composite measures of CAHPS results in standardized formats. Comparative analyses of CAHPS outcomes are greatly enhanced through the National CAHPS Benchmarking Database.

The CAHPS initiative is still a work in progress. It remains uncertain whether satisfaction ratings can meaningfully inform quality improvement (Sofaer, 2002). AHRQ has launched the development of a second generation of CAHPS research to evaluate the system’s utility for quality improvement and to assess its effectiveness in applied settings. The principal objectives of CAHPS II are to develop innovative reporting formats and to create survey instruments for nursing homes and group practices that can be used by persons with mobility impairments (Agency for Healthcare Research Quality, 2001).

Diabetes Quality Improvement Project

DQIP is an example of a disease-specific performance measurement set. The project was funded by CMS to develop a national consensus with regard to a set of standardized process and outcome measures for performance reporting related to the care of adults with diabetes (see Appendix B) (Texas Medical Foundation, 2002). Although the DQIP measure set has

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