Envisioning the National Health Care Quality Report (2001) / Chapter Skim
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Selecting Measures for the National Health Care Quality Data Set
Selecting Measures for the National Health Care Quality Data Set
Pages 76-102
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From page 76... ...
RECOMMENDATIONS RECOMMENDATION 2: The Agency for Healthcare Research and Quality should apply a uniform set of criteria describing desirable attributes to assess potential individual measures and measure sets for the content areas defined by the framework. For individual measures, the committee proposes ten criteria grouped into the three following sets: (1)
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From page 77... ...
Measure selection is a complex process that includes several steps ranging from identifying a set of candidate measures to updating these measures. Activities relating to the definition of the measure set, the reporting of measures, and the eventual interpretation of the findings in the National Health Care Quality Report all require expert input.
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From page 78... ...
The committee agreed that a comprehensive approach to measurement is ideal for the National Health Care Quality Data Set on which the Quality Report will be based. A limited set of measures would be insufficient to capture the four components of quality and the diverse consumer perspectives on health care needs.
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From page 79... ...
Regardless of the number and nature of summary measures that are defined for the Quality Report, information on individual measures that make up He summary measure should also be made available. This will allow interested parties to examine how the summary measures were constructed.
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From page 80... ...
The number and nature of the measures vary according to the area of quality being considered. Sound criteria are needed for the selection of individual measures, as well as for the definition of the measure set for the National Health Care Quality Data Set.
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From page 81... ...
The individual measure criteria are grouped into three major categoriesimportance, scientific soundness, and feasibility (Box 3.1~. Each of these categories refers to different aspects of the process for measure selection.
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From page 82... ...
Specific Aspects to Consider When Selecting Measures Having defined the Free major categories of criteria importance, scientific soundness, and feasibility that should be taken into account when examining possible measures for the National Health Care Quality Data Set, the committee then determined the specific criteria under each of these categories. In doing so, the committee aimed to capture the essential attributes of the final measures with as parsimonious a set of- criteria as possible.
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From page 83... ...
Preferably, the measure will address areas in which there is a clear gap between the actual and potential levels of health that can be influenced by improvements in the quality of care Areas in which there is a large degree of unexplained variation in health status, death rates, or disease rates can also be the subject of measurement when there is reason to believe that quality of care influences the variation (Wennberg and Gittelsohn, 1973~. Many of the health priorities for the next decade spelled out in Healthy People 2010 could apply here (U.S.
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From page 84... ...
For example, while better nutritional counseling may lead to less osteoporosis and bone fractures, the lead time is too long for it to be used as a measure of quality of care. Criteria Regarding Scientific Soundness The second category of criteria is the scientific soundness of the measure.
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From page 85... ...
Outcome measures should be examined for validity in a similar manner.
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From page 86... ...
Since equity and medical conditions will be examined in the Quality Report, measures should be available for relevant groups of the population (for example, by race and ethnicity, level of income, insurance status) and by condition (for example, diabetes, breast cancer, asthma)
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From page 87... ...
Researchers can subsequently perform the statistical analyses required to adjust the data. Evaluating Individual Measures According to the Criteria Each of the criteria described above is a desirable attribute of the measures selected for the report, but not an absolute requirement.
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From page 88... ...
In addition, the measure set should address the problems of diverse groups of the population over the entire life span. To examine potential inequities in the quality of care, it will also be important that the measure set include information on health conditions or clinical areas more prevalent among certain vulnerable populations, such as lower
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From page 89... ...
In contrast, as discussed in Chapter 5, the number of measures in any specific year's Quality Report will be more limited and much smaller than the number of measures included in the data set to facilitate understanding of the report. Robustness Robustness is the third criterion for the measure set.
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From page 90... ...
To actually select individual measures for the data set, AHRQ should evaluate competing measures by examining evidence of their scientific soundness or their validity, reliability, and explicit evidence base. In the long term, it should also assess their feasibility or the existence of measure prototypes; the cost or burden of measurement; the availability of requisite data across the system; and the capacity of the data and the measure to allow comparisons by populations or subpopulations.
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From page 91... ...
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From page 92... ...
Another activity of the advisory body could be to promote research on new measures, the definition of summary measures, and other areas needed to update and improve the Quality Report. Establishing an advisory body can be accomplished through a variety of alternative mechanisms.
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From page 93... ...
This periodic review of measures may also be useful to obtain support from key stakeholders. After an initial period of development, testing, and improvement, updating should tend to be conservative given the extensive process undertaken to define the initial measure set.
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From page 94... ...
TYPES OF MEASURES Role of Summary Measures Deciding whether or not the National Health Care Quality Report should feature summary measures as well as discrete individual measures is one of the most important measurement-related issues. This is a common dilemma that confronts those presenting data on complex subjects such as health care quality.
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From page 95... ...
Summary measures are also more understandable when they are presented with a benchmark or standard as a reference point. Even when summary measures are not possible, the Quality Report should include sets of individual measures based on data from similarly defined populations.
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From page 96... ...
Structure, process, and outcome measures each provide a different piece of the quality picture. However, given the present limitations of each of these types of measures and the generally weak links among them, the committee recommends that the National Health Care Quality Data Set include a balance of outcome-validated process measures and diseasespecif~c or procedure-specific outcome measures.
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From page 97... ...
rather than structure because of the weak links between structure and processes and between structure and outcomes of care (Evans et al., 1998~. Using structural measures of technology could stifle innovation by "locking in" any structures sanctioned for use in the National Health Care Quality Report.
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From page 98... ...
These include the role of an advisory body, revisions to the measure set, measuring quality comprehensively, the role of summary measures, and the use of measures of the structure, processes, and outcomes of care. These are all complex issues, and most do not have clear-cut answers.
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From page 99... ...
At the risk of oversimplification, Box 3.3 lists factors that should be considered in moving toward an ideal measure set. This chapter opens with a set of recommendations that should facilitate reaching that ideal.
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From page 100... ...
2000. The National Quality Forum enters the game.
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From page 101... ...
Presentation to the Institute of Medicine Committee on the National Quality Report on Health Care Delivery, Oakland, Calif., August 18. McGlynn, Elizabeth A., and Steven M
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From page 102... ...
1973. Small area variations in health care delivery.
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