Quality measurement: Where are we?

Leaders from two of the nations top quality organization–Christine Kassel from NQF and Rick Kronick from AHRQ–weigh in on the topic.  In a recent JAMA article, they first note some concerns:

These concerns were underscored by the recent Institute of Medicine report on core metrics for health and healthcare progress,which noted the need to align around a common framework to focus improvement and reduce the effort required for measurement.  Similarly, a recent study by Pronovost et al. found substantial variation in public ratings—with little agreement on which organizations were top performers.

They suggest the following three key steps be taken:

  • Measure alignment: “there is a need to make greater advances in aligning measures and focusing on measures that matter. This will help ensure that clinicians’ efforts on measurement produce a consistent signal that leads to improvement and reduces unnecessary data collection and reporting work.”
  • Focus less on P4P and more on giving accurate, real-time data.  The authors note that the focus of quality measurement has relied too much on extrinsic motivation through monetary rewards for high quality.  Although not stated by the authors, paying for quality also incentivizes physicians to inaccurately report quality in ways that will make them appear better or to pick their patients selectively to improve their quality measures.  Kassel and Kronick recommend giving accurate, real-time data access to providers so that they can find their own ways to improve care.
  • Make measures meaningful to users.  The authors wisely recommend that consulting with different stakeholders is vital to insure the measures captured and communicate represent the metrics of most interest to each stakeholder.

Although there has been a lot of progess made on improving quality and quality measurement, there is clearly a long way to go.


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