Article Discusses New Approach to Performance Measurement
Public reporting on quality performance has become widespread, and financial rewards for demonstrating higher quality are now common. Although there is evidence that measurement and reporting have contributed to improved quality, there also is evidence that current quality monitoring systems have had unintended consequences, and sometimes limited returns. A recent proposal recommended reimagining quality measurement and improvement by developing new approaches to performance measurement. Yet, innovation in performance measurement often appears too risky to healthcare practitioners and organizations because of its potential effect on current publicly reported measures. This article discusses specific barriers to performance measurement and improvement innovations – and proposes a potential mechanism that could promote innovation in healthcare delivery, while maintaining a focus on accountability.
While many recognize the limitations of current performance measures, organizations often resist adopting innovative approaches to measuring quality because these approaches may appear to lower scores on reported measures, even if transiently. For example, measurement of adherence to diabetes medications focuses attention only on patients who have had at least two prescription refills, even though they may be at lower risk than patients who have never filled a prescription. But including those higher-risk patients in the measures would lower overall performance scores. Similarly, organizations that move from using data from medical record review to automated electronic health record data may initially score less well on certain measures because of incomplete data capture. Further, healthcare systems may wish to incorporate more sophisticated measures of life expectancy to determine who is no longer eligible for cancer screening, but doing so might lower scores on standard screening measures that are based solely on age.
One possible approach for encouraging innovation is to allow high-performing entities to experiment with new approaches to measurement and/or care delivery through a Safe Harbors for Improving Performance (SHIP) designation. This designation could allow organizations to suspend measuring some or all of the areas in which they are performing well, in return for pursuing a proposed measurement innovation that could encompass three general themes:
- Improving performance measurement methods for an existing clinical area (i.e., using continuous vs. dichotomous measures to assess blood pressure control);
- Developing and testing measurement approaches in clinical areas not currently monitored; and
- Testing new implementation approaches for performance measurement.
The SHIP designation could be good for five years to allow adequate time for development, testing, and longitudinal tracking. During this time, SHIP organizations would not be required to report on the selected standard measures. The authors suggest that this could allow high-performing organizations to suspend using measures that have outlived their usefulness, and also could help drive the healthcare system toward using more clinically meaningful approaches.
Dr. Kerr is the Director of HSR&D's Center for Clinical Management Research (CCMR), Ann Arbor, MI.
McGlynn E and Kerr E. Creating Safe Harbors for Quality Measurement Innovation and Improvement. JAMA (Viewpoint). January 12, 2016;315(2):129-30.