Quality measurement

Abstract

In the United States, payers of healthcare and home and community-based services, such as the Centers for Medicare & Medicaid Services, have implemented various quality programs as a lever for improving the quality of services. A key component of any quality program is the set of quality measures adopted for use in the program. Quality measure results are calculated at regular intervals for each accountable entity (e.g., organization) and can be shared with the respective organization in confidential feedback reports, they may be displayed on websites (public reporting), and they may be used in pay-for-performance programs to encourage providers to improve the quality of services. In this special communication, we focus on quality outcomes measures, describing quality measure design options using the five core elements of a fully-specified outcome, which have been defined in reporting guidelines for clinical trial protocols (SPIRIT-Outcomes 2022 Extension), and clinical trial reports (CONSORT-Outcomes 2022 Extension). Element 1 of a measure is the domain or subdomain (the concept to be measured), element 2 is the specific measurement items or instrument, element 3 as the specific metric used to characterize participants' results (e.g., end value, change from baseline, time to event), element 4 is the method of aggregation (e.g., mean for continuous data or proportion for categorical data, risk adjustment approach), and element 5 is the timepoint of the follow-up measurements. We explain risk-adjustment for quality measures, which is used to adjust for case-mix differences across providers. We describe considerations for selecting quality measure risk factors, which can be used as covariates in a regression model, stratification variables or exclusion criteria. Finally, we describe quality measure endorsement standards and future directions for quality measurement.