Core Measurement Needs for Better Care, Better Health, and Lower Costs Counting What Counts: Workshop Summary (2013) / Chapter Skim
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3 Current Measurement Capabilities
3 Current Measurement Capabilities
Pages 21-30
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From page 21... ...
• The National Quality Strategy has worked to align agency efforts around the three aims to promote coordination and provide comparable results where possible. • The National Quality Strategy faces a variety of measurement, accessibility, and functionality challenges, all of which will continue to be addressed as the strategy evolves.
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To delve deeper into the status of current metrics implementation, Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ) , led off her panel's discussions with an overview of the National Quality Strategy and its current initiatives, challenges, and future work.
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From page 23... ...
must submit a progress report on the National Quality Strategy to Congress each year, Clancy noted. She gave an overview of the messages relayed in the 2012 update, which established key measures used to track each of the National Quality Strategy's priorities, described how the National Quality Strategy has helped align various measurement approaches used by programs to measure quality, and highlighted efforts in Colorado and Ohio to improve quality along the priorities identified by the National Quality Strategy.
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. Clancy noted, too, that given AHRQ's integral role in the National Quality Strategy Annual Progress Report, the agency has reoriented its National Healthcare Quality and National Healthcare Disparities reports to align with the National Quality Strategy priorities.
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Consumers and purchasers, on the other hand, are typically concerned with the impact and value of measures, favoring composite measures that focus on outcomes for various groups and conditions, rather than measures of process and compliance. Combining the perspectives of both groups, a hierarchy of measures was developed where the highest tier contains outcome measures linked to evidence-based processes, followed by outcome measures of substantial importance supported by plausible processes, then intermediate outcome measures, and finally, process measurements that have a proven impact on outcomes.
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From page 26... ...
By developing systems for continuous improvement and aligning metrics with anticipated delivery and payment changes, Burstin said that the health system as a whole can ensure that core measurement supports positive change and reform toward better care for patients and populations. CONSISTENT AND TIMELY IMPLEMENTATION OF MEASURES To start her discussion of implementation issues, Barbara Gage gave a broad overview of the current measurement landscape.
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Two major implementation challenges to consider are data transfer issues and the challenges in merging data across different systems throughout the entire patient episode. Data transfer requires protecting privacy, addressing security issues, and respecting proprietary information while using standardized provider performance measures to create comparable community metrics.
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and may be collected more directly and in a more timely fashion from patients in the future. Claims data are typically used to measure service utilization, such as hospital readmissions, admissions for conditions that could be treated with ambulatory care, emergency room use, and cost measures, while clinically enhanced measures offer insights in health improvement through tracking high blood pressure control, screening for average blood glucose levels (HbA1c)
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A participant noted that the ability to use information at the service level, where physicians can begin looking at data from other physicians in the same plan, can run into privacy issues that are covered by state regulations. This complexity raises significant implementation issues for health care systems that operate in multiple states.
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