Episode-Based Approaches to Measuring Health Care Quality

Abstract

Most currently available quality measures reflect point-in-time provider tasks, providing a limited and fragmented assessment of care. The concept of episodes of care could be used to develop quality measurement approaches that reflect longer periods of care. With input from clinical experts, we constructed episode-of-care frameworks for six illustrative conditions and identified potential gaps and measure development priority areas. Episode-based measures could assess changes in health outcomes (“delta measures”), the amount of time during an episode in which a patient has suboptimal health status (“integral measures”), quality contingent upon events occurring previously (“contingent measures”), and composites of measures throughout the episode. This article identifies a number of challenges that will need to be addressed to advance operationalization of episode-based quality measurement.

Keywords

episode of care quality indicators health care outcome and process assessment (health care)reimbursement mechanisms

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References

Agency for Healthcare Research and Quality. (2010). National Quality Measures Clearinghouse (NQMC). Retrieved from http://qualitymeasures.ahrq.gov/

Baker

D. W.

Persell

S. D.

Thompson

J. A.

Soman

N. S.

Burgner

K. M.

Liss

Kmetik

K. S.

(2007). Automated review of electronic health records to assess quality of care for outpatients with heart failure. Annals of Internal Medicine, 146, 270-277.

Berry

S. A.

Laam

L. A.

Wary

A. A.

Mateer

H. O.

Cassagnol

H. P.

McKinley

K. E.

Nolan

R. A.

(2011). ProvenCare perinatal: A model for delivering evidence/guideline-based care for perinatal populations. Joint Commission Journal on Quality and Patient Safety, 37, 229-239.

Blumenthal

D. M.

Song

Jena

A. B.

Ferris

T. G.

(2013). Guidance for structuring team-based incentives in healthcare. American Journal of Managed Care, 19(2), e64-e70.

Burwell

S. M.

(2015). Setting value-based payment goals—HHS efforts to improve US health care. New England Journal of Medicine, 372, 897-899.

Cassel

C. K.

Conway

P. H.

Delbanco

S. F.

Jha

A. K.

Saunders

R. S.

Lee

T. H.

(2014). Getting more performance from performance measurement. New England Journal of Medicine, 371, 2145-2147. doi:10.1056/NEJMp1408345

Dreyer

N. A.

Garner

(2009). Registries for robust evidence. Journal of the American Medical Association, 302, 790-791. doi:10.1001/jama.2009.1092

Friedberg

M. W.

Damberg

C. L.

McGlynn

E. A.

Adams

(2010). Methodological considerations in generating provider performance scores for use in public reporting by chartered value exchanges. Rockville, MD: Agency for Healthcare Research and Quality.

Fung

C. H.

Hays

R. D.

(2008). Prospects and challenges in using patient-reported outcomes in clinical practice. Quality of Life Research, 17, 1297-1302.

10.

Glicklich

R. E.

Dreyer

N. A.

(Eds.). (2010). Registries for evaluating patient outcomes: A user’s guide (2nd ed.). Rockville, MD: Agency for Healthcare Research and Quality.

11.

Haddad

F. S.

Thakrar

R. R.

Hart

A. J.

Skinner

J. A.

Nargol

A. V. F.

Nolan

J. F.

. . . Case

C. P.

(2011). Metal-on-metal bearings the evidence so far. Journal of Bone & Joint Surgery, British Volume, 93, 572-579.

12.

Hofer

T. P.

Hayward

R. A.

Greenfield

Wagner

E. H.

Kaplan

S. H.

Manning

W. G.

(1999). The unreliability of individual physician “report cards” for assessing the costs and quality of care of a chronic disease. Journal of the American Medical Association, 281, 2098-2105.

13.

Hornbrook

M. C.

Hurtado

A. V.

Johnson

R. E.

(1985). Health care episodes: Definition, measurement and use. Medical Care Research and Review, 42, 163-218.

14.

Hussey

P. S.

Sorbero

M. E.

Mehrotra

Liu

Damberg

C. L.

(2009). Episode-based performance measurement and payment: Making it a reality. Health Affairs, 28, 1406-1417. doi:10.1377/hlthaff.28.5.1406

15.

Kennedy

D. M.

Stratford

P. W.

Wessel

Gollish

J. D.

Penney

(2005). Assessing stability and change of four performance measures: A longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskeletal Disorders, 6(1), 3.

16.

Kerr

E. A.

Smith

D. M.

Hogan

M. M.

Hofer

T. P.

Krein

S. L.

Bermann

Hayward

R. A.

(2003). Building a better quality measure: Are some patients with “poor quality” actually getting good care? Medical Care, 41, 1173-1182.

17.

Krumholz

H. M.

Normand

S.-L. T.

Spertus

J. A.

Shahian

D. M.

Bradley

E. H.

(2007). Measuring performance for treating heart attacks and heart failure: The case for outcomes measurement. Health Affairs, 26, 75-85. doi:10.1377/hlthaff.26.1.75

18.

Macurdy

Theobald

Kerwin

Ueda

(2008). Prototype medicare resource use report based on episode groupers (Prepared for Centers for Medicare and Medicaid Services). Burlingame, CA: Acumen.

19.

McGlynn

E. A.

Schneider

E. C.

Kerr

E. A.

(2014). Reimagining quality measurement. New England Journal of Medicine, 371, 2150-2153. doi:10.1056/NEJMp1407883

20.

Mechanic

R. E.

Altman

S. H.

(2009). Payment reform options: Episode payment is a good place to start. Health Affairs, 28, w262-w271. doi:10.1377/hlthaff.28.2.w262

21.

Mechanic

R. E.

Santos

Landon

B. E.

Chernew

M. E.

(2011). Medical group responses to global payment: Early lessons from the “Alternative Quality Contract” in Massachusetts. Health Affairs, 30, 1734-1742. doi:10.1377/hlthaff.2011.0264

22.

National Priorities Partnership. (2008). National priorities and goals: Aligning our efforts to transform America’s healthcare. Retrieved from https://psnet.ahrq.gov/resources/resource/8745/national-priorities-and-goals-aligning-our-efforts-to-transform-americas-healthcare

23.

National Quality Forum. (2009). Measurement framework: Evaluating efficiency across patient-focused episodes of care. Washington, DC: Author.

24.

National Quality Forum. (2014). Finding common ground for healthcare priorities: Families of measures for assessing affordability, population health, and person- and family-centered care. Washington, DC: Author.

25.

O’Connor

P. J.

Bodkin

N. L.

Fradkin

Glasgow

R. E.

Greenfield

Gregg

. . . Sutherland

J. E.

(2011). Diabetes performance measures: Current status and future directions. Diabetes Care, 34, 1651-1659.

26.

Peterson

E. D.

DeLong

E. R.

Masoudi

F. A.

O’Brien

S. M.

Peterson

P. N.

Rumsfeld

J. S.

. . . Shaw

R. E.

(2010). ACCF/AHA 2010 position statement on composite measures for healthcare performance assessment: American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop a Position Statement on Composite Measures). Journal of the American College of Cardiology, 55, 1755-1766. doi:10.1016/j.jacc.2010.02.016

27.

Porter

M. E.

Teisberg

E. O.

(2006). Redefining health care: Creating value-based competition on results. Boston, MA: Harvard Business Press.

28.

Price

R. A.

Elliott

M. N.

Zaslavsky

A. M.

Hays

R. D.

Lehrman

W. G.

Rybowski

. . . Cleary

P. D.

(2014). Examining the role of patient experience surveys in measuring health care quality. Medical Care Research and Review, 71, 522-554.

29.

Reeves

Campbell

S. M.

Adams

Shekelle

P. G.

Kontopantelis

Roland

M. O.

(2007). Combining multiple indicators of clinical quality: An evaluation of different analytic approaches. Medical Care, 45, 489-496.

30.

Reinhardt

U. E.

(2006). Health reform: Porter and Teisberg’s utopian vision. Retrieved from http://healthaffairs.org/blog/2006/10/10/health-reform-porter-and-teisbergs-utopian-vision/

31.

Robinson

J. C.

(2006). Let’s admit Porter and Teisberg are (sometimes) right. Retrieved from http://healthaffairs.org/blog/2006/10/05/health-care-reform-let%E2%80%99s-admit-porter-and-teisberg-are-sometimes-right/

32.

Rodondi

Peng

Karter

A. J.

Bauer

D. C.

Vittinghoff

Tang

. . . Selby

J. V.

(2006). Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus. Annals of Internal Medicine, 144, 475-484.

33.

Sandy

L. G.

Rattray

M. C.

Thomas

J. W.

(2008). Episode-based physician profiling: A guide to the perplexing. Journal of General Internal Medicine, 23, 1521-1524.

34.

Selby

J. V.

Uratsu

C. S.

Fireman

Schmittdiel

J. A.

Peng

Rodondi

. . . Kerr

E. A.

(2009). Treatment intensification and risk factor control: Toward more clinically relevant quality measures. Medical Care, 47, 395-402.

35.

Singer

S. J.

Burgers

Friedberg

Rosenthal

M. B.

Leape

Schneider

(2011). Defining and measuring integrated patient care: Promoting the next frontier in health care delivery. Medical Care Research and Review, 68, 112-127. doi:10.1177/1077558710371485

36.

Solon

J. A.

Feeney

J. J.

Jones

S. H.

Rigg

R. D.

Sheps

C. G.

(1967). Delineating episodes of medical care. American Journal of Public Health, 57, 401-408.

37.

Thomas

Caplan

Levey

J. M.

Cohen

Leonard

Caldis

Mueller

(2009). Clinician feedback on using episode groupers with Medicare claims data. Health Care Financing Review, 31(1), 51-61.

38.

Thompson

Wang

Xie

Kolassa

Rajan

Tseng

C. L.

. . . Safford

M. M.

(2005). Assessing quality of diabetes care by measuring longitudinal changes in hemoglobin A1c in the veterans health administration. Health Services Research, 40(6 Pt 1), 1818-1835. doi:10.1111/j.1475-6773.2005.00439.x

39.

Tinetti

M. E.

Fried

T. R.

Boyd

C. M.

(2012). Designing health care for the most common chronic condition—Multimorbidity. Journal of the American Medical Association, 307, 2493-2494.

40.

U.S. Department of Health and Human Services. (2012). 2012 Annual progress report to Congress: National strategy for quality improvement in health care. Washington, DC: Author.

41.

Voorham

Denig

Wolffenbuttel

B. H. R.

Haaijer-Ruskamp

F. M.

(2008). Cross-sectional versus sequential quality indicators of risk factor management in patients with type 2 diabetes. Medical Care, 46, 133-141.

42.

Wunderlich

G. S.

(1992). Toward a national health care survey: A data system for the 21st century. Washington, DC: National Academies Press.

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