The Patient Protection and Affordable Care Act (PPACA) requires healthcare quality to be measured in meaningful ways in six broad areas, and a viewpoint article in the June 5 Journal of the American Medical Association provides a map for how to get there.
The authors recommend that quality measurements be focused less on processes and more on outcomes, be uniform across healthcare systems and payers, and be easier for clinicians to collect. Physician leaders from the Centers for Medicare & Medicaid Services, the Department of Health and Human Services, and the Agency for Healthcare Research and Quality authored the recommendations.
The ACA requires healthcare quality be assessed for clinical care, patient experience and engagement, population and community health, safety, care coordination, and cost and efficiency. The private National Quality Forum has partnered with the federal Department of Health and Human Services and the Centers for Medicare & Medicaid Services to review and endorse measurements that assess quality in these six areas in useful, broadly applicable ways.
In many cases, quality in healthcare should be refocused on patient outcomes instead of process measurements, the authors state.
Processes are often easy to measure, but what’s easy to measure may not always be important, noted Molly Cooke, MD, FACP, president of the American College of Physicians.
“Things that can be pulled from a chart review … may not be very comprehensive or ambitious measures. It is important to keep pushing, and the two areas we need to push are: Is the measure that we are looking at really important in terms of the health of individual patients or communities of patients? The second is do we have a good measure for it?“ said Dr. Cooke, who was not involved with the JAMA article.
In some cases, the authors note, processes that are routinely measured now have becomes standard practice at hospitals – such as giving beta blockers to patients with heart attacks – so measuring them no longer provides helpful information.
Data on some processes should still be collected, however, noted Dr. Helen Burstin, PhD, senior vice president of performance measurement for the National Quality Forum. For instance, she said, it’s important to continue to monitor how information flows from patient to clinicians, which could be gleaned via patient surveys.
“They [patients] get to say ‘the medications were explained to me in a way I understand’ or ‘I understand what the warnings are to return to the emergency department,” said Dr. Burstin.
Uniform data collection
In addition to being meaningful, quality measurements should be standardized across healthcare systems and payers, according to the recommendations.
For example, quality measurements for Medicare patients should also be applicable to non-Medicare patients, said Dr. Burstin. Data should be collected in a consistent way across government agencies, health plans and health systems so that statistics can be compared across those platforms. Currently, data measuring the same process or outcome is often gathered in slightly different ways from health plan to health plan or from community to community, so the statistics cannot be compared across the board.
The authors also note that healthcare quality should be evaluated at three levels: for individual healthcare providers, for hospitals or medical groups, and for communities, with feedback provided at each level.
In addition, collection of quality measurements should be easier for doctors and other healthcare providers to gather, the authors state, noting that electronic heath records are ideal for gathering and analyzing data, but are not yet being used to their full potential. It’s important that gathering data does not take a lot of time or distract physicians and other healthcare providers from caring for patients, the authors note. They recommend that EHRs be interoperable across platforms and include more automated data collection systems that work with patients’ smartphones and tablet computers.
“We really need to make our electronic health records work much better in terms of making the data collection for these metrics just part of what the doctor or nurse practitioner is doing in the normal care of the patient,” said Dr. Cooke. “We are still a bit away from having important measures drop out of the normal clinical work.”
Barriers: cost and complexity
The biggest challenges for transforming the way quality is measured are the cost and complexity of developing more meaningful methods for measuring health care quality, said Dr. Burstin.
“Those are difficult data to collect, especially in a way that the collection is reliable and valid,” said Dr. Burstin. “They are expensive and they take a long time to develop.”
It’s also crucial to educate clinicians that gathering quality data will yield helpful information and is not just another government regulation they have to meet, said Dr. Cooke.
“Physicians overwhelmingly want to achieve good outcomes for our patients,” she said. “It is an absolute fact that without data, we overestimate the quality if our work, and we don’t really understand where our own gaps are until we see the data.”