A new National Quality Forum (NQF) report provides guidance on reducing unnecessary variation in healthcare quality measures so that measurement can be more uniform and have greater impact on improving care.
“Quality measures are essential building blocks in large-scale public- and private-payer efforts to reform the nation’s healthcare system. But slightly different versions of the same measure contribute to waste through reporting burden for providers and make performance comparisons more difficult,” said Helen Darling, MA, NQF’s interim president and CEO.
A 2013 NQF-commissioned analysis from Bailit and Associates identified 1,367 quality measures in use across 48 different state and regional programs. Of these measures, 509 were distinct and the remaining 800+ measures overlapped or had similar focus, with one or more variations in the specifications.
While there are numerous reasons why measure developers or implementers develop measure variants, including a need for more innovative measures, NQF’s work focused on how to reduce unintended variation. NQF’s environmental scan identified reasons for measure variation, including end-user preferences, changes to the evidence underlying a measure, or implementation challenges such as access to needed data. The lack of awareness of existing measures also is an important driver of unintended variation. To help reduce variation, the NQF report recommends the development of a comprehensive database of measures that are under development and in use to improve awareness of measures and any variants among those developing or using measures.
“NQF’s work to address measure variation is a leading example of how we are working to resolve some of the most challenging issues in measurement. We have an urgent need to focus on the measures that really matter for quality improvement,” said Helen Burstin, MD, MPH, NQF’s chief scientific officer. “To make care better for patients, in addition to reducing variation in measures, it’s also important that we eliminate measures that are duplicative, ineffective, or that have reached the limits of their usefulness.”
Funded by the U.S. Department of Health and Human Services, NQF’s Variation in Measure Specifications project convened a 16-member multistakeholder panel of experts in measure development and implementation, health informaticists, provider groups representing those who are being measured, purchasers, payers, and others who use measure results. Their goal was to understand how, why, and where the tweaking of measures is occurring; promote a common understanding of the key terms, concepts, and measure components; and create a structure for understanding and interpreting variation across measures.
The Expert Panel developed a decision-logic framework to reduce measure variation, with a focus on how best to improve the comparability and interpretability of measures, while driving transparency and innovation and reducing burden.
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