JGIM Supplement Features Ten Articles by VA Researchers on Next Generation Clinical Performance Measures

BACKGROUND:
Funded by VA's Health Services Research and Development (HSR&D) Service, this Journal of General Internal Medicine (JGIM) Supplement is the product of an HSR&D sponsored state-of-the-art (SOTA) conference titled "Next Generation Clinical Performance Measures: Patient-Centered, Clinically Meaningful, and High-Value," which was held in 2014. A Call for Papers was issued following the SOTA, and 10 articles were accepted for publication in this special Supplement. Published papers discuss empirical research on the effects of performance measurement on improvements in clinical care, as well as on unintended outcomes (e.g., inappropriate treatment or over-treatment). Papers also describe new methods and methodological challenges in the selection and creation of performance measures that incorporate measures of benefit and harm, value, or patient preferences, and also present research on the implementation of performance measures that address human factors, incentives and facilitators, barriers, and expected and unintended consequences.

Articles include, but are not limited to the following:

• Phibbs and colleagues developed inpatient stroke electronic clinical quality measures that are part of the Meaningful Use (MU) program to improve inpatient stroke care. They found that stroke MU indicators can be accurately generated from existing VA electronic health record (EHR) data (nearly a 90% match to chart review), but accuracy decreased slightly when centrally stored national data was relied on compared to more complete local data sources.
• Farmer and colleagues developed electronic population-based, longitudinal quality metrics for depression care. They found that despite rapid growth in the primary care population in VA from FY2000-2010, increasing by more than one million Veterans, the detection of new episodes of depression (8%) and minimally appropriate treatment rates (84%) remained stable. This suggests that VA was able to maintain a standard of care while treating significantly more patients each year.
• Etingen and colleagues assessed the relationship between patient-reported experience measures (PREMs) such as measures of patient-centered care, and healthcare quality metrics in a large sample of Veterans receiving VA healthcare. Findings suggest that PREMs are an effective way to engage patients, consider their experiences and preferences, and obtain deeper understanding than that provided by simple measures of patient satisfaction.
• Kondo and colleagues conducted a systematic review on pay-for-performance (P4P) and found that while there was limited evidence from which to draw strong conclusions, findings suggest that P4P programs should evolve over time in response to periodic evaluation and should target areas of poor performance. Moreover, measures and incentives should align with organizational priorities, and providers should be engaged in designing the implementation of measures.
• Harris and colleagues evaluated whether or not implementing a substance use disorder continuity-of-care quality measure in Network Directors' performance contracts would result in expected improvements in measured performance, and found it was associated with an increase in measured performance from 23% before the measure was implemented to 48% by the end of the study.
• Saini and colleagues discussed the development of an electronic measure of the overuse of screening colonoscopy for Veterans who were screened between 2011 and 2013. They found that compared to results obtained from manual record review, the electronic measure was highly specific (97%) for overuse, but was not sensitive (20%), suggesting that some overuse might be missed.

Journal of General Internal Medicine. April 2016;31(1 Suppl):1497-1525.