Clinical Quality Measures: A Challenge for-and to-Family Physicians

Area of Science:

• Health Services Research
• Quality Improvement Science

Background:

• Clinical quality measures are crucial for reducing healthcare harms and costs.
• Current methods for evaluating measure appropriateness lack systematic, reproducible, and widely accepted approaches.

Purpose of the Study:

• To develop and apply a robust methodology for evaluating the appropriateness of clinical quality measures for performance measurement.
• To inform the selection of measures for quality improvement initiatives and incentive programs.

Main Methods:

• Defined 10 criteria across 4 domains: patient-centeredness, measure specification, evidence of benefit, and independence from confounders.
• Applied these criteria to 24 clinical quality measures considered for statewide use in Massachusetts.
• Appraised each measure as Appropriate or Not Appropriate.

Main Results:

• 15 measures (62.5%) were rated Appropriate.
• 3 measures (12.5%) were conditionally appropriate for system-level use only.
• 6 measures (25%) were rated Not Appropriate due to issues like unclear benefits, patient autonomy concerns, or confounding factors.

Conclusions:

• A consensus-driven, 10-criteria methodology effectively evaluates clinical quality measure appropriateness.
• This approach can enhance measure design and guide the selection of optimal measures for quality measurement, financial incentives, and reporting.