for Assessment of Measures
with the Subcommittee co-chairs, AHRQ and CMS identified five criteria that were
relevant to the goals of the Medicaid adult core set, were responsive to public
comment themes, and represented sound measurement.
criterion considers whether a measure assessed a condition that had high
prevalence, impact on the health care system, and/or impact on health care
costs for the Medicaid adult population. An additional consideration was
whether the area of measurement had demonstrated gaps in care, either
documented in the literature or seen in current performance rates. The measure
was also considered important if it was seen as actionable by States, Medicaid
health plans, or relevant provider organizations.
- Scientific evidence around the issue
criterion addresses whether the measure promoted an intervention (e.g.,
screening, management, or follow-up) or process (e.g., care coordination) that is
supported by evidence and clinical guidelines.
- Scientific soundness of the measure
criterion addresses whether the measure was shown to be valid (credible, measures
what it intends to measure) and reliable (the extent to which a measure gives
- Current use in and alignment with existing programs
response to public comment requests, a measure's use (or proposed use) in
existing programs was included as a criterion for evaluation. Existing programs
included the Initial Core Set of Children's Health Care Quality Measures, HEDIS
Health Plan Accreditation, Physician Quality Reporting, the National Quality
Strategy aims and priorities, and the Medicare and Medicaid Electronic Health
Record Incentive Payment Programs.
- Feasibility for State reporting
the Medicaid adult core set aims to produce State-level information, this
criterion considers whether the measure as currently specified could be
feasible for States to report.
Information and Documentation
order to assess how each measure fared against the five criteria, AHRQ and CMS collected
the following information on each measure from the measure owners/developers.
Measure description, numerator,
denominator, and exclusions.
Data sources (e.g., claims,
medical records, electronic health records).
Description of health importance,
prevalence, financial importance, and opportunity for improvement, including
what is known about gaps in care and health care disparities.
Brief description of the
scientific literature, including what is known about effectiveness of the
intervention being addressed, and what is known about management and follow-up.
Published clinical guidelines
relevant to the measure.
Validity and reliability results,
including a description of the study sample and methods used.
Use (or proposed use) in existing programs
(Federal or other).
Performance rates (most recent and
two years prior).
questions were listed on a measure form that was sent to each measure owner/developer
for completion. When these measure forms were not received from owners, forms
that had been completed by measure stewards for National Quality Forum
endorsement were substituted (if they existed). All forms were compiled and
sent to Subcommittee members prior to the Subcommittee's two-day meeting.
and CMS convened the Subcommittee for an in-person meeting on August 9-10, 2011
in Washington, DC. As was done in the initial meeting, the Subcommittee was
divided into four workgroups that addressed areas important to
Medicaid-eligible adults: Maternal/Reproductive Health, Overall Adult Health,
Complex Health Care Needs, and Mental Health and Substance Use.
of the 51 measures in the recommended core set was assigned to one of the workgroups
based on its relevance to the topic area. The 43 measures suggested in public
comment were assigned to workgroups in the same manner. However, members were
advised that these measures would only be moved to a vote if there was an
active recommendation by a workgroup for that measure to be added for consideration
by the whole Subcommittee.
workgroup discussed its assigned measures, reviewing the measures' supporting
documentation and public comment results. Workgroups were instructed to strive
for consensus on how each of their measures fared against the five criteria. Each
workgroup completed a Measure Evaluation Form (Appendix 7) and rated measures as
Low, Medium, or High for each criterion. After this
exercise, the workgroup discussed each measure as a whole, balancing the
different criteria, identifying any trade-offs among the criteria, and coming
to consensus on an overall recommendation for the measure.
the workgroup reviews, the full Subcommittee convened for voting. Prior to each
measure's vote, the chair of the workgroup that evaluated the measure summarized
the workgroup's discussion, overall recommendation,
and rationale. The Subcommittee then voted using an electronic process that
allowed for anonymous voting by each member.
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