JAMA Commentary: Transparency Standards for Diabetes Performance Measures
Regardless of the direction U.S. healthcare reform takes, performance measurement, public reporting, and accountability will play major roles. Moreover, the development and adoption of performance measures must be transparent. Transparency has been defined as "a process by which information about existing conditions, decisions and actions is made accessible, visible and understandable."
Hemoglobin A1c control is an important intermediate outcome for measuring quality of care provided to more than 20 million Americans with diabetes. However, considerable debate has occurred over the past decade concerning what hemoglobin A1c levels are appropriate for public reporting. It is not clear why different organizations have come to different decisions regarding the level of hemoglobin A1c, and in 2008, a new study raised concerns about aggressive target values for performance measures. As a result of this study and other trials showing no significant cardiovascular benefit of tight glycemic control, the National Committee for Quality Assurance (NCQA) indicated that the current recommended level of <7% would be reevaluated given that "new evidence demands a new examination of this measure."
This Commentary discusses several examples of transparency that might help guide the development of performance measures in the future. Authors suggest that, considering the potential effect on millions of patients and the high cost of antiglycemic medications alone, the upfront investment in ensuring evidence-based, transparently developed performance measures would be worthwhile to protect the public health and restore public and professional confidence.
Aron D and Pogach L. Commentary: Transparency standards for diabetes performance measures. JAMA January 14, 2009;301(2):210-212.
Drs. Aron and Pogach are Co-Clinical Coordinators for VA/HSR&D’s Diabetes Mellitus Quality Enhancement Research Initiative (DM-QUERI).