Holding Providers Accountable for Health Care Outcomes.

Area of Science:

• Health Services Research
• Quality Improvement
• Healthcare Policy

Background:

• Federal programs increasingly rely on outcome measures for public reporting, payment, and accreditation.
• The validity and accuracy criteria for these outcome measures are not well-defined, impacting their appropriate use.
• Effective outcome measures require a strong link to provider influence and accurate risk adjustment for patient populations.

Purpose of the Study:

• To propose and apply criteria for assessing the validity and accuracy of healthcare outcome measures.
• To evaluate current outcome measures used in federal accountability programs.
• To identify deficiencies in existing outcome measures and inform future development.

Main Methods:

• Developed four criteria to assess outcome measures: provider influence, outcome precision, risk-adjustment accuracy, and absence of adverse consequences.
• Applied these criteria to 10 outcome measures used in federal accountability programs.
• Analyzed claims-based mortality measures and patient-reported outcome measures.

Main Results:

• Only 3 out of 10 evaluated outcome measures met all four proposed criteria.
• Five measures, including all 4 claims-based 30-day mortality measures, failed to meet at least one criterion.
• Patient-reported outcome measures present challenges due to potential bias from low response rates.

Conclusions:

• Existing outcome measures used in federal programs often lack sufficient validity and accuracy for accountability purposes.
• There is a critical need for a national dialogue to establish robust standards for judging healthcare outcome measures.
• Refining outcome measure development and assessment is crucial for accurate quality assessment and effective healthcare policy.