Overall Recommendations
Improving Performance Measures
- Performance measures should be constructed so that the credit for
achieving the measure is commensurate with the likelihood of benefit to the
patient, consistent with the Institute of Medicine definitions of quality. The
most credit should be given for achieving goals or clinical actions with large
potential benefits in downstream outcomes for the patient (e.g., based on life
expectancy, comorbidity, etc.).
- Performance measures should be constructed so that the eligible
population reflects the population(s) that will receive the benefit.
- Performance measures should motivate improvements in quality
while minimizing problems with patient safety and unintended consequences.
- Performance measures should be improved through the use of
clinically detailed data, and the limitations of measures that use only
utilization data should be disclosed.
- Performance measures should incorporate, when possible,
considerations of patient preferences and patient choice.
- Performance measures should incorporate patient assessments of
quality.
- When operationalizing performance measures, differences in
quality across special population groups should be assessed so that appropriate
quality improvement interventions can be implemented, as necessary.
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Recommendations for Future Research
Participants identified many avenues of possible future
research and questions to be tested. The main themes included:
- Test alternate specifications for technical quality measures for
their potential to improve risk factor control and motivate or minimize
unintended consequences. Measures to be tested should include tightly linked
clinical action measures, continuous weighted measures (including those
incorporating QALY metrics), longitudinal measures, and dichotomous stringent
control measures.
- Work with health plans and health care organizations to develop
and test methods to systematically capture detailed clinical data (e.g.,
pharmacy, laboratory) for incorporation into technical quality measures; test
the reliability of measures constructed with these data.
- Test alternate specifications of patient-reported quality
measures for their potential to improve risk factor control and motivate or
minimize unintended consequences.
- Develop and implement measures that incorporate patient
preferences and clinical factors as components of quality assessments. In
particular, test methods that incorporate factors such as medication
intolerance, frailty, life-expectancy, and comorbidities into risk-factor
control assessments of patient preferences and goals.
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Next Steps
Research ideas and potential research projects to test some
of the above recommendations are being discussed with the National Committee
for Quality Assurance, Kaiser Permanente of Northern California, and the
Department of Veterans Affairs, Veterans Health Administration.
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