Selecting quality of care and resource use measures is an important and challenging task for organizations striving to improve the quality of health care in their communities. This Decision Guide is designed to inform readers about the most critical issues to consider when selecting and adopting such performance measures.
Prepared by: Patrick Romano, M.D., M.P.H., Peter Hussey, Ph.D., and Dominique Ritley, M.P.H.
List of Stakeholder Questions
Foreword: Improving Quality One Community at a Time
Part I. Introduction to Performance Data
Part II. Introduction to Measures of Quality
Part III. Introduction to Resource Use/Efficiency Measures
Part IV. Selecting Quality and Resource Use Measures
Part V. Interpreting Quality and Resource Use Measures
Appendix A. Measure Evaluation Framework
Appendix B. Contacts for Chartered Value Exchanges
Appendix C. Glossary
List of Stakeholder Questions
Part I: Introduction to Performance Data
Question 1. What data, including both national and State sources, are readily available to collaboratives for performance measurement at the hospital and physician levels?
Question 2. What are the strengths and weaknesses of using administrative data, medical record data, and hybrid data?
Question 3. What are the opportunities and challenges in building a multipayer/multi-data source database or data warehouse?
Question 4. Should a vendor be used for data collection and management? If so, what are the criteria for selecting a vendor?
Question 5. How should a data auditing program be designed to ensure data quality?
Question 6. How do HIPAA and other privacy regulations affect data collection and public reporting?
Part II: Introduction to Measures of Quality
Question 7. How are quality performance measures constructed, and what are the implications of how their numerators and denominators are specified?
Question 8. What specific measures can be used to calculate physician performance at the individual or organization level?
Question 9. What specific measures can be used to calculate hospital performance regionally or nationally?
Question 10. What is the role and value of composite measures, and what are the most common approaches to constructing composites?
Question 11. What is “risk adjustment” and how is it best applied?
Question 12. What are the opportunities and challenges to using patient experience surveys to measure hospital or physician performance at the regional or State level?
Question 13. What is the “Better Quality Information” pilot project, sponsored by the Centers for Medicare & Medicaid Services, and what can be learned from it?
Part III: Introduction to Resource Use/Efficiency Measures
Question 14. What are the main types of resource use measures?
Question 15. What types of data are used to construct resource use measures? How is “cost” measured?
Question 16. What is known about the validity of available resource use measures, including their advantages and disadvantages?
Question 17. Which national groups are developing or endorsing resource use measures?
Question 18. How have resource use measures been used to compare providers to benchmarks?
Part IV: Selecting Quality and Resource Use Measures
Question 19. What national initiatives and forces are driving the standardization of quality measurement?
Question 20. How can the Institute of Medicine's six “quality domains,” the National Priorities Partnership's six National Priorities, and Donabedian's “structure, process, and outcome” typology be used to select appropriate measures of quality?
Question 21. What are the roles and responsibilities of the organizations that endorse or approve measures versus those organizations that develop measures?
Question 22. What criteria should we use when screening measures of quality for public reporting or other purposes
Question 23. Against which benchmarks should we measure our local performance
Question 24. When and how should providers review data before public reports are released?
Question 25. What are the critical success factors for selecting useful performance measures?
Part V: Interpreting Quality and Resource Use Measures
Question 26. How can quality and resource use measures be evaluated together to help identify high-value and low-value providers?
This Decision Guide is intended for use by community quality collaboratives interested in evaluating quality and resource use measures. The guide presents answers to 26 questions, identified in collaboration with representatives from the Agency for Healthcare Research and Quality (AHRQ) Chartered Value Exchanges.
The authors gratefully acknowledge the following people for reviewing a formative draft of this document:
- Catherine Baase, Michigan Health Information Alliance
- Craig Brammer, Health Improvement Collaborative of Greater Cincinnati
- Karen DeSalvo, Louisiana Health Care Quality Forum
- R. Adams Dudley, University of California-San Francisco
- Rob Ence, Utah Partnership for Value-Driven Health Care
- David Kelley, Pittsburgh Regional Health Initiative
- Mark Legnini, Engelberg Center for Health Care Reform/The Brookings Institution
- Cathie Markow, California Chartered Value Exchange
- Aucha Prachanronarong, Center for Medicare & Medicaid Services
- Joachim Roski, Engelberg Center for Health Care Reform/The Brookings Institution
- Karen Shore, Center for Health Improvement
- David Shute, Oregon Health Care Quality Corporation
- Mark Sonneborn, Minnesota Healthcare Value Exchange
- Amy Topel, Wisconsin Healthcare Value Exchange
In addition, the following AHRQ staff members reviewed the document in addition to their regular work: Roxanne Andrews, John Bott, Christine Crofton, Katherine Crosson, Jan De La Mare, Anne Elixhauser, Irene Fraser, Peggy McNamara, Mamatha Pancholi, Jennifer Schnaier, Carol Stocks, and Herbert Wong.
William Encinosa, AHRQ, Michael Painter, Robert Wood Johnson Foundation, Nancy Brands Ward, Center for Health Improvement, and Nancy Wilson, AHRQ, provided targeted feedback. In addition, the authors extend their appreciation to Colleen Cameron, David Chin, and Tammy Gee, University of California, Davis; and Michele Peterson at the Center for Health Improvement for their valuable technical assistance.
This document is in the public domain and may be used and reprinted without permission. AHRQ appreciates citation as to source. Suggested format follows:
Romano PS, Hussey P, Ritley D. Selecting Quality and Resource Use Measures: A Decision Guide for Community Quality Collaboratives. Rockville, MD: Agency for Healthcare Research and Quality; May 2010. AHRQ Publication No. 09(10)-0073.