Using the AHRQ National Quality Measures Clearinghouse™ to Assess Diabetes Quality Measurement

Slide Presentation from the AHRQ 2011 Annual Conference

On September 19, 2011, Brian Leas made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (125 KB). Plugin Software Help.

Slide 1

 Using the AHRQ National Quality Measures Clearinghouse™ to Assess Diabetes Quality Measurement

Using the AHRQ National Quality Measures Clearinghouse™ to Assess Diabetes Quality Measurement

Brian Leas, MS, MA
University of Pennsylvania Health System

AHRQ Annual Conference
September 19, 2011

Slide 2

 Background

Background

  • Research Objectives:
    • Evaluate the state of diabetes quality measurement, utilization & impact.
    • Determine key strengths, weaknesses, gaps.
    • Develop strategies to enhance value and impact of diabetes measures.
  • Research Team:
    • Thomas Jefferson University School of Population Health:
      • David Nash, Principal Investigator.
      • Kathryn Kash, Qualitative Interviewer.
      • Neil Goldfarb, Co-Investigator.
      • Rich Toner, Research Coordinator.
      • Al Crawford, Measurement Analyst.
      • Brian Leas, Project Manager.
      • Bettina Berman, Measurement Analyst.
  • Timeline: Spring 2008—Summer 2009.
  • Funding:
    • National Changing Diabetes Program of Novo Nordisk.

Slide 3

Methodology

Methodology

  • Environmental scan of diabetes quality measures:
    • Measure developers: Accreditation agencies, payers, physician groups, QI organizations, state/local initiatives.
    • All types of measures: Process, outcome, safety, etc.
    • Specifications: Definitions, inclusion/exclusion, time frame.
    • Scope: Broadly representative of key sectors, rather than fully comprehensive.
  • Key informant interviews:
    • Measure developers, physicians, payers, employers, QI orgs.
    • Representation from all relevant stakeholder groups.
    • Interviewees expert in both technical development and practical utilization of quality measures.
    • Semi-structured, recorded.

Slide 4

Search Strategy

Search Strategy

  • Step 1: National Quality Measures Clearinghouse™ (NQMC):
    • Keywords: "diabetes" and "diabetes mellitus".
    • 98 measures identified.
  • Step 2: Supplemental search:
    • Roster compiled of key organizations & known measure sets.
    • Reviewed Web sites, contacted organizations for information.
    • 48 additional measures identified.
  • Step 3: Data abstracted into Excel® spreadsheet.

Slide 5

 Measure Abstraction

Measure Abstraction

  • Descriptive characteristics:
    • Brief description.
    • Clinical topic (e.g., HgbA1c mgmt, lipid profile, foot exam).
    • Developer.
    • Release and revision dates.
    • Broader measurement set.
    • Web site link.
    • NQMC identification #.
  • Specifications:
    • Level of measurement (e.g., clinician, health plan).
    • Source of data (e.g., administrative, medical record, pharmacy, lab, registry).
    • Numerator / denominator.
    • Inclusion / exclusion.
    • Time frame.

Slide 6

 Measure Abstraction

Measure Abstraction

  • Validity:
    • Supporting evidence.
    • Extent of measure testing.
    • Composition of development group.
    • Endorsement by the National Quality Forum (NQF) and others.
  • Policy-relevant domains*:
    • AHRQ: Process, outcome, access, structure, use of services, patient experience, population health.
    • Institute of Medicine (IOM): Effectiveness, efficiency, equity, patient-centeredness, safety, timeliness.

*Dimensions as of 2008.

Slide 7

 Key Informant Interviews

Key Informant Interviews

  • Measure development, selection, endorsement:
    • National Committee for Quality Assurance.
    • National Quality Forum.
    • American Medical Association.
    • Centers for Medicare and Medicaid Services.
    • Ambulatory Quality Alliance.
    • Pharmacy Quality Alliance.
    • American Board of Medical Specialties.
    • American Board of Internal Medicine.
    • American College of Physicians.
    • Wisconsin Collaborative for Healthcare Quality.
  • Measure Utilization and Value:
    • Blue Cross Blue Shield Association.
    • Center for Disease Control and Prevention.
    • Institute of Healthcare Improvement.
    • America's health Insurance Plans.
    • American Academy of Family Physicians.
    • Nat'l Business Coalition on Health.
    • American Diabetes Association.
    • American Association of American Endocrinologists.
    • American Association of Diabetes Educators.

Slide 8

Findings  

Findings

  • Scope of Measurement:
    • Nearly 150 measures in > 25 distinct clinical categories.
    • Primarily process measures.
    • Substantial redundancy.
    • Widely varying specifications.
    • Evidence base often weak or unclear.
  • Measurement Gaps:
    • Primary prevention.
    • Outcomes of care.
    • Patient perspectives.
    • Coordination of care.
    • Access to care.

Slide 9

 Perspectives on NQMC

Perspectives on NQMC

  • Highly useful for identifying relevant measures:
    • Although 1/3 of measures in our study had not been included in NQMC, many were later submitted by their respective authors.
    • Sufficiently specific and sensitive.
    • Capability to stratify by numerous categories.
    • Only known resource for identifying and comparing measure sets from different sources.
  • Limitations:
    • Time lag from development to submission to posting.
    • Relies on self-reporting.
    • Until recently, limited data available on evidence base, validity, conflicts of interest.

Slide 10

 Questions?

Questions?

  • Brian Leas.
  • Research Analyst.
  • Center for Evidence-based Practice.
  • University of Pennsylvania Health System.
  • Brian.leas@uphs.upenn.edu.
Page last reviewed March 2012
Internet Citation: Using the AHRQ National Quality Measures Clearinghouse™ to Assess Diabetes Quality Measurement. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/leas/index.html