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8 Common Themes
Pages 77-92

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From page 77... ... The workshop summarized in this document had broad objectives, including examining a vision for core health metrics; drawing lessons from national, state, community, and organizational efforts; identifying the metrics that could reliably measure care outcomes, costs, and health improvement; and describing the implementation strategies for these measures. With a scope this broad, the discussions were similarly wide-ranging. Read the entire page →
From page 78... ... Core measure sets can help these diverse groups work together by defining a common target for improvement and identifying the areas where data need to be collected. Finally, a common set of core measures can be used to guide the creation of a robust, rational digital infrastructure. Read the entire page →
From page 79... ... Understanding these varied perspectives is critical for ensuring the usefulness of any core metric set; gathering these perspectives requires broad engagement across the health and health care system. This broad engagement also can uncover other factors that affect a metric's actionability for different stakeholders, such as the stakeholder's access to the underlying data for this metric, a stakeholder's ability to affect the metric, and whether the metric captures processes or health outcomes that are most in need of improvement. Read the entire page →
From page 80... ... A current effort to advance aligned measures is the Measure Applications Partnership convened by the National Quality Forum, which has identified families of measures that could be used in core measure sets and which provides feedback for federal measurement efforts. In addition, the Institute of Medicine has produced several reports examining various areas of measurement, including Performance Measurement (IOM, 2006) Read the entire page →
From page 81... ... measures, Medicaid/CHIP Pediatric Health Care Quality Health Care Measures) • RSA (e.g., HRSA Clinical Quality Core Measure Set) Read the entire page →
From page 82... ... cost, and overall health improvement, and Table 8-2 summarizes the potential metric categories that were discussed by each group. For population health measurement, the breakout group leader noted that the discussions differentiated between measures that reflect current health versus measures that capture factors and contributors to future health. Read the entire page →
From page 83... ... One theme that several participants raised was the need to minimize the overall measurement burden in cost, time, and effort. One speaker described the efforts in his measurement work to derive measurement from data collected by routine care and health monitoring. Read the entire page →
From page 84... ... These example metrics vary in their specificity, comprehensiveness, and actionability. Some workshop participants noted that conceptual overlaps existed between the metric categories, such as between the example metrics for effectiveness in the health care domain and the metrics for current health in the population health domain. Read the entire page →
From page 85... ... For example, one participant noted that some organizational cultures view measurement and data as a weapon, while other organizational cultures promote the view that regular feedback is a welcome opportunity to improve. Several participants noted that these organizational and social factors can determine whether a metric set actually leads to improvement and is used throughout the health and health care system. Read the entire page →
From page 86... ... 86 CORE MEASUREMENT NEEDS TABLE 8-3 Example Metrics for Describing the Core Measurement Needs of the Three-Part Aim Potential Metric Metric Domain Categories Example Metrics Cross-Cutting Current health • ength of life: L Mortality, life expectancy • uality of life: Q Morbidity, functional status, indicator diseases, self-reported health status Equity Population Health • omposite measures: C and QALY, HALY, DALY Variation Contributors and • xtrinsic risks: E risks to future healthy communities, health physical and social environment • ntrinsic risks: I health risks, health behaviors Patient-centered • atient engagement P and experience, HCAHPS metrics • hared decision S making • atient–clinician P communication • elf-management S Equity Health Care • imeliness and access T and to needed care Variation Effective • verall mortality, O mortality amenable to health care (risk adjusted) , overall modifiable risk of death Read the entire page →
From page 87... ... COMMON THEMES 87 TABLE 8-3 Continued Potential Metric Metric Domain Categories Example Metrics Cross-Cutting Effective • unctional status F improvements/ changes from treatments and interventions, changes in modifiable risk factors, patient reported outcomes, clinician-reported outcomes • isease-specific D outcome targets, time to recovery or time to return to function • dherence to A clinical guidelines, appropriateness of care Safe • edical errors, health M care–associated infections, overuse/ Health Care underuse/misuse Equity continued • omposite medical C and harm measure Variation (including medical errors and health associated infections) Value and efficiency • tilization: U Ambulatory care– sensitive admissions and readmissions, care performed in most appropriate setting • ffective management E Coordination and • imeliness T communication • are transitions C • nformation sharing I and communication among care team (including patient and family) Read the entire page →
From page 88... ... in the cost measures breakout group noted that overall health care spending measures need to be the goal, but progress at the local level will depend on specific utilization measures, such as emergency department use or the utilization of advanced imaging technologies. Other participants noted that families of measures can be useful for ensuring that metrics are useful at different levels of aggregation. Read the entire page →
From page 89... ... What Are the Data Infrastructure Needs? A prerequisite to assessment is the ability to routinely capture the key data elements that populate core measures and to exchange those data elements across data systems. Read the entire page →
From page 90... ... Risk adjustment is challenging because of the number of potential methods for adjusting measures and the role that risk adjustment plays in promoting buy-in among clinical providers. How Can the Metrics and the Process Be Most Future-Oriented? Read the entire page →
From page 91... ... 2012. Feasibility of evaluating the CHIPRA care quality measures in electronic health record data. Read the entire page →

From page 77...

... The workshop summarized in this document had broad objectives, including examining a vision for core health metrics; drawing lessons from national, state, community, and organizational efforts; identifying the metrics that could reliably measure care outcomes, costs, and health improvement; and describing the implementation strategies for these measures. With a scope this broad, the discussions were similarly wide-ranging.

8 Common Themes Pages 77-92

8 Common Themes
Pages 77-92