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

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

Brian Leas, MS, MA
University of Pennsylvania Health System

AHRQ Annual Conference
September 19, 2011

Slide 2

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

• 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

• 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

• 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

• 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

• 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

• 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

• 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?

• Brian Leas.
• Research Analyst.
• Center for Evidence-based Practice.
• University of Pennsylvania Health System.
• Brian.leas@uphs.upenn.edu.