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Improving quality measure maintenance: navigating the complexities of evolving evidence
Thomas B Valuck1, Sarah Sampsel, David M Sloan
1Discern Health, 1120 N Charles St, Ste 200, Baltimore, MD 21201.
The American Journal of Managed Care
|June 19, 2019
Summary
Healthcare quality measures require timely updates when evidence changes to ensure accurate patient care and payment. A case study highlights the need for collaboration among stakeholders to improve measure maintenance processes.
Area of Science:
- Health Services Research
- Quality Improvement Science
- Medical Informatics
Background:
- Effective healthcare quality measures depend on clear, evidence-based standards.
- Outdated measure specifications can confuse providers and lead to suboptimal patient care.
- Changes in the evidence base necessitate prompt updates to quality measures.
Purpose of the Study:
- To examine the impact of delayed updates to healthcare quality measures.
- To identify challenges in aligning quality measures with evolving evidence.
- To advocate for improved collaboration and shared responsibility in measure maintenance.
Main Methods:
- Case study analysis of two specific healthcare quality measures.
- Examination of the lag time between evidence changes and measure specification updates.
- Review of the impact on clinical decision-making and payment programs.
Main Results:
- Evidence supporting two quality measures changed, but revised specifications were implemented slowly.
- Delayed updates created confusion and potentially impacted patient care and payment integrity.
- Coordination issues among clinical experts, measure developers, and health plans contributed to the lag.
Conclusions:
- Timely updates to healthcare quality measures are crucial for effective care and payment.
- Shared responsibility and improved coordination among stakeholders are needed for efficient measure maintenance.
- A national dialogue is necessary to enhance measure update processes and address evolving evidence.
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