Existing quality measures should be winnowed down from several hundred to two dozen, according to “Moving the Needle to Meaningful Health Care Quality Measurement,” the first in a three-part series of white papers by the Council of Accountable Physician Practices (CAPP), a coalition of multispecialty medical groups and health systems based in Alexandria, VA.
“An emphasis should be placed on measures for preventive care through immunizations and screenings, management of chronic diseases such as congestive heart failure and diabetes, and other areas where better performance translates into meaningful health improvements. Outcomes should also be measured more definitively,” the report says. “For example, asthmatics should not just be measured on whether they received their medication, but whether they take it, whether they suffered any asthma attacks, and whether they were able to undertake their normal exercise regimen.”
The CAPP report says a more meaningful quality measurement system would include both fewer and better measures, focusing on clinical areas with evidence that improvements in performance result in actual improvements to patient health.
CAPP advocates a set of about 24 measures in a limited number of domains. These would include prevention and chronic disease management and result in meaningful quality information.
“It is critical that physicians and other stakeholders continue to advance the science of outcomes (as opposed to process) measurement, focusing on those that are meaningful to patients — for example, return to normal functioning after illness. The initial focus for external reporting must be on areas where there is strong evidence that process improvements lead to clear improvements in population health and well-being. Examples include: immunization rates, colon cancer screening rates, use of beta-blockers in patients with heart failure, and control of lipids and blood pressure in diabetics,” according to the report.
“Another important piece of ensuring the right measures is being nimble enough to change directions if the technology or science changes rapidly. For example, the Centers for Disease Control and Prevention recently recommended that 11- to 12-year-olds receive two doses of Human Papillomavirus vaccine at least six months apart, rather than the previously recommended three doses. However, many quality-reporting systems have not changed their standard, so that a medical practice complying with the clinical recommendation of two doses may be penalized financially for failing to meet the measurement standard of three doses.”
The healthcare community also should advance the science of outcomes measurement, CAPP says, focusing on outcomes that patients care about. The group cites the example of measuring whether an asthmatic adult received proper medication, when the measure that really matters is whether he or she suffered an acute asthma-related traumatic event or died. Another useful measure would be whether the prescribed treatment allowed the patient to continue his or her daily three-mile walks to and from work.
“One challenge in shifting from process to outcomes measures is the long time horizon required for many outcomes to become apparent. Healthcare buyers make purchasing decisions in one-year increments, an artifact of the one-year insurance cycle,” according to the report. “Patients may switch plans and doctors each year, making it difficult to attribute high-quality, longer-term outcomes to the practice that originally provided the care.”
