Vital Signs Core Metrics for Health and Health Care Progress (2015) / Chapter Skim
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3 Improving the Impact of Measurement
3 Improving the Impact of Measurement
Pages 101-120
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From page 101... ...
In setting out to identify a core measure set, the Committee explored the ways in which targeting core priorities can accelerate change, identified criteria for a core measure, developed criteria for a core measure set overall, and considered lessons learned from examples of existing sentinel measurement efforts. Complexity and rapid proliferation present a significant challenge for health and health care measurement.
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From page 102... ...
If the same set were implemented at the national, state, local, and organizational levels, these benefits would be multiplied as a result of the enhanced ability to make comparisons and determine best practices. While each of the measures in a candidate core measure set could be used for a variety of purposes, the set as a whole would have specific applicability for measuring health, with each measure offering complementary and mutually supportive pathways to improvement.
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From page 103... ...
Rather, a core set can raise the profile of the most compelling health challenges facing the nation; draw attention to issues and actions that can trigger broader-scale system improvement; provide a platform for harmonizing efforts to monitor national, state, local, and institutional progress in health and health care; create opportunities for alignment and the resolution of redundancies in areas in which measurement is burdensome; and guide the creation of a more robust multilevel data infrastructure. Focusing attention primarily on the results of core interest but not prescribing the precise measures to be used to ensure progress toward those outcomes will encourage organizational attention to focus on the most important issues, limit the formal reporting burden, and ensure that other performance improvement measures are tailored to local needs and interests.
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From page 104... ...
Core measure sets can help these diverse groups work together by defining a common target for improvement and identifying the areas in which data need to be collected and shared. Core measures can also highlight areas of greatest urgency for the health system as well as compelling opportunities for change.
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From page 105... ...
This issue is especially problematic when one is considering health outcome measures, as effects may be seen only years or even decades after an intervention. A wellspecified and -maintained core measure set can bring relative permanence and consistency to monitoring of the health system, such that meaningful comparisons can be made not only among regions and systems but also across time.
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From page 106... ...
For example, the Vermont Blueprint for Health used core measure sets to identify the necessary data elements that its electronic health record systems should capture during routine care. In this case, the core set of measures served as the basis for a data dictionary around which the electronic health record system was designed.
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From page 107... ...
Criteria for core measures and for a core measure set (discussed in the next section) are presented in Box 3-1.
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From page 108... ...
Not only should the measures selected reflect the most critical issues at present for the health of the public; they should also be able to show progress over time toward key aims, such that any improvement in the results of core measures should indicate as clearly and directly as possible a real, meaningful advance in the performance and quality of the health system and, more broadly, the health of the public. For some measures, for example, current performance may already be at a high level, such that additional investment in monitoring and improving may be of limited value.
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From page 109... ...
For example, a measure such as self-reported health status can be implemented for populations at multiple levels, from a small community to the nation as a whole, and the concept of wellness represented by this measure is highly relevant for stakeholders both within and external to the health care system. CRITERIA FOR THE CORE SET Building on lessons learned from previous initiatives to select core measures, the Committee developed criteria for the core measure set to guide the selection process.
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From page 110... ...
Thus the core set should be agnostic to the route or strategy taken to achieve improvement, encouraging innovation in addressing the highest-priority health problems. Further, a core measure set orientation to outcomes, while importantly incorporating selected process elements, is likely to be a more direct measurement of what a strategy for improvement is intended to achieve.
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From page 111... ...
Representative Just as critical as the number of measures is the extent to which they represent the most critical issues and priorities of the American health system. As such, the Committee evaluated the core set using the criterion of "representativeness," or the extent to which the core set reflected health realities.
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From page 112... ...
Box 3-2 lists the sentinel measurement initiatives that the Committee considered closely in its review, and these measure sets are also reproduced in full in Appendix D Figure 3-2 illustrates the heterogeneity of measurement areas and topics covered by these sentinel measurement initiatives.
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From page 113... ...
O • NC: Meaningful Use Clinical Quality Measures for Providers (2014) O • regon Health Authority: Coordinated Care Organization Core Measures O • Patient-Centered Medical Home Evaluators Collaborative • Premier: QUEST Measures • State of California: Let's Get Healthy California • State of Massachusetts: Standard Quality Measure Set • tate of Minnesota: Statewide Quality Reporting and Measurement System S • State of the USA Health Indicators • State of Vermont: ACO Core Measure Set • UnitedHealth Foundation: America's Health Rankings • University of Wisconsin: County Health Rankings • Veterans Health Administration: ASPIRE Measure Set • World Health Organization Millennium Development Goal Scorecard NOTE: Selected measure sets are not intended to provide a complete list or a representative sample.
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From page 114... ...
NOTE: EHR = electronic health record; HC = health care. it does illustrate the range and heterogeneity of sentinel measurement efforts already under way.
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From page 115... ...
The project will work to implement the measure set for total cost of care and resource use developed by HealthPartners. This measure set was chosen because it is a public set for which substantial documentation is available on the HealthPartners website, and it has been endorsed by the National Quality Forum (NQF)
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From page 116... ...
CollaboRATE: Involving Patients in the Development of a Shared Decision-Making Measure CollaboRATE illustrates measure development initiatives addressing patient experience and engagement and provides an example of how patients and families can be directly involved in the measure development
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From page 117... ...
. During this process, three core shared decision-making tasks were identified -- provision of information, elicitation of patient preferences, and integration of patient preferences in decision making -- and three corresponding items were constructed to form the CollaboRATE measure.
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From page 118... ...
Large numbers of measure sets were identified, and despite being drawn from similar national sources, the measure sets of individual states are either measuring different data or tailoring measures to meet state-dependent demands. The Buying Value Report is intended to describe the scope of the problem and to provide
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From page 119... ...
measures. Also noteworthy is that California appears to have better-aligned measure sets (perhaps because of the CHART program described above)
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From page 120... ...
2014. The population value of quality indicator reporting: A framework for prioritizing health care performance measures.
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