Pathway to Patient-Centered Measurement for Accountability
HealthAffairs 9/12/19
Much of the focus in health policy circles and the media has been on the price transparency provisions of the recently released executive order on improving price and quality transparency. However, the executive order also calls for the establishment of a health quality roadmap that outlines a process for alignment of measures across all federal programs and care settings, adoption of common measures, and elimination of “low-value or counterproductive measures.”
The health quality roadmap will need to address several key questions including:
- What is the purpose of measurement?
- What do “high-value and productive” measures look like?
- What is a feasible pathway to evolving measurement?
In this post, we address these and other important questions and discuss the importance of developing patient-centered outcomes measures. We provide an overview of our approach, which is described in more detail in a just-released white paper and was developed through multistakeholder convenings and a review of existing measures and measurement frameworks. We argue that a confluence of factors makes this an ideal time to move forward with these next generation of measures.
Principles Of Measures For Accountability
Irrespective of whether they are culled from existing measures or are newly developed, measures used for accountability purposes should be outcome-oriented, patient-centered, sourced from different types of data, and longitudinal and site-agnostic:
Outcomes-Oriented
Measures should be focused on outcomes or be primarily outcomes-oriented and include measures sourced from different types of data: administrative, clinical, and patient-reported. They should also incorporate the concept of “appropriateness,” for example, avoiding unnecessary imaging studies for low back pain or ensuring appropriateness of pharmacologic prescribing, which involves ensuring that patients receive the “right” treatments.
Patient-Centeredness
As transformation efforts place patients and their preferences at the forefront of their care, measures used in accountability programs will need to mirror this shift.
Measures should be patient-centered and incorporate new approaches to assessing patient health status and patient experience. Such measures would include assessment of clinical outcomes, patient-reported outcome measures, as well as new approaches to evaluation of patient experience. For example, many patients use Yelp-style reviews or social media to access provider performance information; we need to find valid and reliable ways of tapping into these avenues or creating rigorous Yelp-like platforms for the purposes of assessing health system performance. A variety of data sources will be needed for these different types of patient-centered outcomes measures. Measures that assess complications post-surgery could be based on claims or a combination of claims and clinical data. Functional status measures would rely on patient-reported data collected using validated instruments such as the HOOS, JR. (hip disability and osteoarthritis outcome score)–KOOS, JR. (knee injury and osteoarthritis outcome score).
Longitudinal And Site Agnostic
Measures should be longitudinal and (as appropriate) agnostic of site of care. In other words, they should assess performance of the delivery system over time and across settings.
